Deoxycorticosterone (DOC) is a C-21 (21 carbon atoms) steroid hormones synthesized in the zona fasciculata (ZF) and zona glomerulosa (ZG) of the adrenal gland and is a precursor for the synthesis of cortisol and aldosterone (see the image below).
The reference range for DOC can be seen in the table below.
Table 1. Deoxycorticosterone Reference Range (Open Table in a new window)
|Conventional units||SI units|
|Male||3.5-11.5 ng/dL||106-333 pmol/L|
|Follicular phase||1.5-8.5 ng/dL||45-257 pmol/L|
|Luteal phase||3.5-13 ng/dL||91-393 pmol/L|
|1st trimester||5-25 ng/dL||151-757 pmol/L|
|2nd trimester||10-75 ng/dL||303-2270 pmol/L|
|3rd trimester||30-110 ng/dL||908-3329 pmol/L|
|< 1 y||7-57 ng/dL||212-1725 pmol/L|
|1-5 y||4-49 ng/dL||121-1483 pmol/L|
|Male||9-34 ng/dL||272-1029 pmol/L|
|Female||2-13 ng/dL||61-393 pmol/L|
DOC is an intermediate in the biosynthesis of the major corticosteroids and not a major adrenal secretory product. Therefore, elevated serum DOC levels are clinically important in only a few disease states that involve enzymatic deficiencies, generalized adrenal hyperfunction, or direct adrenal tumor production. Decreased serum DOC levels occur in enzymatic deficiencies “upstream” from DOC synthesis or generalized adrenal hypofunction.
Congenital adrenal hyperplasia (CAH) due to 11β-hydroxylase (CYP11B1) and 17α-hydroxylase deficiency
As a result of the enzymatic defects, the ACTH level increases because of the absence of the cortisol negative feedback; this increase in the ACTH leads to the accumulation of cortisol precursors proximal to the enzymatic deficiency. These precursors can be converted to adrenal androgen leading to virilization in females and premature adrenarche in both genders. In the case of 11-hydroxylase and 17-hydroxylase deficiency, the cortisol precursor is DOC, which can act as a mineralocorticoid leading to low-renin hypertension and hypokalemia (see image below). For further reading, please see the Medscape Reference topic C-17 Hydroxylase Deficiency.
CAH due to aldosterone synthase (CYP11B2) causes a decrease in aldosterone level without affecting cortisol levels.
DOC-producing tumor may exist.
Primary cortisol resistance syndrome, due to defects in glucocorticoid receptors and characterized by increase in ACTH, cortisol and cortisol precursors including DOC, can lead to hypertension and hypokalemia.
Severe ACTH-dependent Cushing syndrome may exist.
Levels may be elevated during pregnancy and the first week of life.
Serum DOC is decreased in the following:
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, 3-beta-steroid dehydrogenase deficiency, or steroidogenic acute regulatory protein (StAR) deficiency.
Primary or secondary adrenal insufficiency
Collection and Panels
Patient instruction: No need for fasting, morning sample preferred
Collection tube: Red-top tube
Unacceptable conditions: Hemolyzed specimens
Specimen preparation: Separate serum from cells and transfer to transport tube.
Storage/transport temperature: Frozen
Stability: Refrigerated 7 days; frozen 14 days
Deoxycorticosterone (DOC) is a C-21 (21 carbon atoms) steroid hormone synthesized in zona fasciculata (ZF) and zona glomerulosa (ZG) of the adrenal gland and is a precursor for the synthesis of cortisol and aldosterone (see the image below).
In the ZG under the effect of Aldosterone synthase (CYP11B2), DOC is converted to aldosterone through a process including other precursor (corticosterone and 18-hydroxycorticosterone); CYP11B2 gene transcription is under control of angiotensin II.
In the ZF under the effect of the 17α-hydroxylase, DOC is converted to 11-deoxycortisol and then later is converted to cortisol by the 11β-hydroxylase (CYP11B1), an enzyme mainly available in the ZF that is under the effect of ACTH.
Although CYP11B1 and CYP11B2 share 95% homology, the former regulates the final steps in cortisol synthesis, whereas the latter regulates the final steps in aldosterone synthesis.
DOC was one of the earliest corticosteroids to be synthesized and later isolated from bovine adrenal glands (1938). Synthetic DOC acetate was the first corticosteroid shown to be effective in treating Addison disease.
Authoritative texts dismiss DOC as a weak mineralocorticoid (MC) and negligible glucocorticoid. The bulk of the evidence, however, support the concept that DOC is a potent MC, which in excess, can produce sodium retention, low-renin hypertension, and kaliuresis. Although DOC binds less avidly to GC receptor than cortisol, it is an effective GC replacement in the treatment of Addison and postadrenalectomy patients.
Table 2. Relative Blood Levels, Production Rates, and Bioactivity of DOC, Aldosterone, and Cortisol (Open Table in a new window)
|Blood Level||3-10 ng/dl||10-20 ng/dl||10,000-30,000 ng/dl|
|Production Rate||90 ug/day||100-200 ug/day||25,000 ug/day|
|MC Receptor Affinity||+++||+++||+++|
|GC Receptor Affinity||+||++||++|
DOC should be measured in conjunction with other hormone as part of the work up for the following:
Low renin hypertension
CAH due to aldosterone synthase (CYP11B2; not associated with low cortisol)
At birth, the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-gonadal axis are activated, and all adrenal steroids are high, including mineral corticoids and sex steroids and their precursors. In preterm infants, elevations can be even more pronounced due to illness and stress. In doubtful cases, when the initial test was performed on a just-born baby, repeat testing a few days or weeks later is advised.
Elevated serum DOC level is not diagnostic for any disease, and it should be measured with other hormones, including 11-deoxycortisol, 17-hydroxyprogesterone, aldosterone, and cortisol measurements.
Serum DOC level can be measured as part of the high-dose ACTH stimulation to confirm the presence of a mild cases of 11β-hydroxylase deficiency.