Clinical use: Clinicians may use the testing of androstenedione for: –

  1. Diagnosis and differential diagnosis of hyperandrogenism (in conjunction with measurements of other sex-steroids). In house testosterone measurements should be performed initially. Depending on results, this may be supplemented with measurements of sex hormone-binding globulin and other androgenic steroids (e.g dehydroepiandrosterone sulfate [DHEAS]).
  2. Diagnosis of congenital adrenal hyperplasia (CAH), in conjunction with measurement of other androgenic precursors, particularly, 17-alpha-hydroxyprogesterone (OHPG) 17-alpha-hydroxypregnenolone, DHEA-S, and cortisol.
  3. Monitoring CAH treatment, in conjunction with testosterone, OHPG, DHEAS, and DHEA.
  4. Diagnosis of premature adrenarche, in conjunction with gonadotrophins and other adrenal and gonadal sex-steroids and their precursors.
Background: Androstenedione is secreted predominately by the adrenal gland and production is at least partly controlled by adrenocorticotropic hormone (ACTH). It is also produced ACTH – independent in the testes and ovaries from adrenal-secreted dehydroepiandrosterone sulfate (DHEAS). Androstenedione is a crucial sex-steroid precursor.Androstenedione production during life mimics the pattern of other androgen precursors. Fetal serum concentrations increase throughout embryonal development and peak near birth at approximately young adult levels. Levels then fall rapidly during the first year of life to low prepubertal values. With the onset of adrenarche, androstenedione raises gradually, a process that accelerates with the onset of puberty, reaching adult levels around age 18.

Elevated Androstenedione levels can cause symptoms or signs of hyperandrogenism in women. Men are usually asymptomatic, but through peripheral conversion of androgens to oestrogens can occasionally experience mild symptoms of oestrogen excess, such as gynecomastia. Most mild-to-moderate elevations in androstenedione are idiopathic. However, pronounced elevations of androstenedione may be indicative of androgen-producing adrenal or gonadal tumours.

In children, adrenal and gonadal tumours are uncommon, but many forms of congenital adrenal hyperplasia (CAH) can increase serum Androstenedione concentrations. Diagnosis always requires measurement of other androgen precursors (e.g OHPG, 17-alpha-hydroxypregnenolone, and DHEAS) and cortisol, in addition to Androstenedione.

Reference ranges: Female (adult): 1.0 – 11.5 nmol/L
Male (adult): 2.1 – 10.8 nmol/L

Referral lab does not offer a paediatric range.

Associated diseases:
Patient preparation: None required
Specimen requirements: Serum. Blood specimen in plain (red top) or SST.
Turnaround time: 1 week
Additional information:
Referred test: Referred test
Location: Royal Victoria Infirmary