Reference Range

The reference range of urinary 17-hydroxyprogesterone (17-OHPG) in children is as follows:^{[1, 2, 3]}

Age 3 days to 1 year: Up to 50 ng/24 hours
Age 1-8 years: Up to 300 ng/24 hours

The following is the reference of urinary 17-OHPG in adults:

Males: Up to 2 µg/24 hours
Females: Up to 4.5 µg/24 hours

Interpretation

Elevated urinary 17-hydroxyprogesterone (17-OHPG) levels are associated with the following:

Congenital adrenal hyperplasia (CAH)
Polycystic ovarian syndrome (PCOS)

Collection and Panels

Specifics for collection and panels are as follows:

Specimen type: Urine
Collection method: 24-hour urine collection (see image below)

Urine sample.
Specimen volume: 10 mL
Other instructions: Record duration and total volume

Description

An elevated level of 17-OHPG, an intermediate in the synthesis of adrenocortical hormones, is the distinguishing characteristic of 21-hydroxylase (CYP21) deficiency, the most common form of CAH.

Urine 17-OHPG is also frequently elevated in patients with PCOS or idiopathic hirsutism.

Indications/Applications

CAH is a general term for a group of inherited disorders in which a defect in cortisol biosynthesis results in overproduction of adrenocorticotropin hormone (ACTH), with secondary adrenal hyperplasia as a consequence. Classic CAH is generally recognized at birth or in early childhood because of ambiguous genitalia, salt wasting, or early virilization. Nonclassic adrenal hyperplasia is generally recognized at or after puberty because of oligomenorrhea or virilizing signs in females.

Indications for testing of urinary 17-OHPG include the following:

In a male child with premature sexual development
In females with hirsutism, other signs of virilization, oligomenorrhea, or infertility

A study by Itonaga et al indicated that the first morning value of pregnanetriol, a urinary metabolite of 17-hydroxyprogesterone, can be used in place of serum/blood 17-hydroxyprogesterone to monitor 21-hydroxylase deficiency, the most common type of CAH. The investigators found that, prior to glucocorticoid administration, a significant positive correlation exists between the first urinary pregnanetriol measurement and that of blood 17-hydroxyprogesterone.^[4]