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HelpOrder Code ANST Androstenedione, Serum
Additional Codes
Epic Order ID LAB518
Reporting Name
Androstenedione, SUseful For
Diagnosis and differential diagnosis of hyperandrogenism, in conjunction with measurements of other sex steroids
Diagnosis of congenital adrenal hyperplasia (CAH), in conjunction with measurement of other androgenic precursors, particularly, 17-alpha-hydroxyprogesterone (OHPG), 17 alpha-hydroxypregnenolone, dehydroepiandrosterone sulfate (DHEA-S), and cortisol
Monitoring CAH treatment, in conjunction with testosterone, OHPG, DHEA-S, and DHEA
Diagnosis of premature adrenarche, in conjunction with measurement of follicle-stimulating hormone and luteinizing hormone as well as other adrenal and gonadal sex-steroids and their precursors
Testing Algorithm
For more information see Steroid Pathways.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Serum RedOrdering Guidance
Additional Testing Requirements
For diagnosis and differential diagnosis of hyperandrogenism, an initial workup in adults should also include total and bioavailable testosterone (TTBS / Testosterone, Total and Bioavailable, Serum) measurements. Depending on results, this may be supplemented with measurements of sex hormone-binding globulin (SHBG1 / Sex Hormone-Binding Globulin, Serum) and other androgenic steroids (eg, dehydroepiandrosterone sulfate [DHEA-S]).
For diagnosis of congenital adrenal hyperplasia (CAH), the following assays should also be ordered:
-OHPG / 17-Hydroxyprogesterone, Serum
-DHES1 / Dehydroepiandrosterone Sulfate, Serum
-CORT / Cortisol, Serum
For monitoring CAH treatment, the following assays should also be ordered:
-TTST / Testosterone, Total, Mass Spectrometry, Serum
-OHPG / 17-Hydroxyprogesterone, Serum
-DHES1 / Dehydroepiandrosterone Sulfate, Serum
-DHEA_ / Dehydroepiandrosterone [DHEA], Serum.
For diagnosis of premature adrenarche, the following assays should also be ordered:
-FSH / Follicle-Stimulating Hormone [FSH], Serum
-LH / Luteinizing Hormone [LH], Serum
-TTBS / Testosterone, Total and Bioavailable, Serum or TGRP / Testosterone, Total and Free, Serum
-EEST / Estradiol, Serum
-DHES1 / Dehydroepiandrosterone Sulfate, Serum
-DHEA_ / Dehydroepiandrosterone (DHEA), Serum
-SHBG1 / Sex Hormone-Binding Globulin, Serum
-OHPG / 17-Hydroxyprogesterone, Serum
Specimen Required
Collection Container/Tube: Red top (serum gel/SST are not acceptable)
Submission Container/Tube: Plastic vial
Specimen Volume: 0.6 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum Red | Refrigerated (preferred) | 28 days | |
| Frozen | 28 days | ||
| Ambient | 7 days |
Special Instructions
Reference Values
PEDIATRICS*
Premature infants
26-28 weeks, day 4: 92-282 ng/dL
31-35 weeks, day 4: 80-446 ng/dL
Full-term infants
1-7 days: 20-290 ng/dL
1 month-1 year: <69 ng/dL
Males*
|
Tanner stages |
Age (Years) |
Reference range (ng/dL) |
|
Stage I (prepubertal) |
<9.8 |
<51 |
|
Stage II |
9.8-14.5 |
31-65 |
|
Stage III |
10.7-15.4 |
50-100 |
|
Stage IV |
11.8-16.2 |
48-140 |
|
Stage V |
12.8-17.3 |
65-210 |
Females*
|
Tanner stages |
Age (Years) |
Reference range (ng/dL) |
|
Stage I (prepubertal) |
<9.2 |
<51 |
|
Stage II |
9.2-13.7 |
42-100 |
|
Stage III |
10.0-14.4 |
80-190 |
|
Stage IV |
10.7-15.6 |
77-225 |
|
Stage V |
11.8-18.6 |
80-240 |
*Soldin SJ, Brugnara C, Wong EC, eds. Androstenedione. In: Pediatric Reference Ranges. 4th ed. AACC Press; 2003: 32-34
ADULTS
Males: 40-150 ng/dL
Females: 30-200 ng/dL
For SI unit Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Day(s) Performed
Monday through Friday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
82157
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ANST | Androstenedione, S | 1854-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 7730 | Androstenedione, S | 1854-9 |
Clinical Information
Androstenedione is secreted predominately by the adrenal gland and production is at least partly controlled by adrenocorticotropic hormone (ACTH). It is also produced independent of ACTH in the testes and ovaries from adrenal-secreted dehydroepiandrosterone sulfate (DHEA-S). Androstenedione is a crucial sex-steroid precursor. It lies at the convergence of the 2 biosynthetic pathways that lead from the progestins to the sex steroids, being derived either via:
-C3-dehydrogenation of DHEA
-Catalyzed by 3-beta-hydroxysteroid dehydrogenase-2 (adrenals and gonads)
-17,20-lyase (CYP17A1)-mediated side-chain cleavage of 17-alpha-hydroxyprogesterone (OHPG)
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 rises gradually, a process that accelerates with the onset of puberty, reaching adult levels around age 18. Adrenarche is a poorly understood phenomenon peculiar to higher primates that is characterized by a gradual rise in adrenal androgen production. It precedes puberty but is not causally linked to it. Early adrenarche is not associated with early puberty, or with any reduction in final height, or overt androgenization, and is generally regarded as a benign condition not requiring intervention. However, girls with early adrenarche may be at increased risk of polycystic ovarian syndrome as adults, and some boys may develop early penile enlargement.
Elevated androstenedione levels can cause symptoms or signs of hyperandrogenism in women. Men are usually asymptomatic but through peripheral conversion of androgens to estrogens, can occasionally experience mild symptoms of estrogen 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 tumors.
In children, adrenal and gonadal tumors are uncommon, but many forms of congenital adrenal hyperplasia can increase serum androstenedione concentrations. Diagnosis always requires measurement of other androgen precursors (eg, OHPG, 17-alpha-hydroxypregnenolone, and DHEA-S) and cortisol, in addition to androstenedione.
For more information see Steroid Pathways.
Clinical Reference
1. Bidlingmaier F, Wagner-Barnack M, Butenandt O, Knorr D. Plasma estrogens in childhood and puberty under physiologic and pathologic conditions. Pediatr Res. 1973;7(11):901-907. doi:10.1203/00006450-197311000-00006
2. Von Schnakenburg K, Bidlingmaier F, Knorr D. 17-hydroxyprogesterone, androstenedione, and testosterone in normal children and in prepubertal patients with congenital adrenal hyperplasia. Eur J Pediatr. 1980;133(3):259-267
3. Sciarra F, Tosti-Croce C, Toscano V. Androgen-secreting adrenal tumors. Minerva Endocrinol. 1995;20(1):63-68
4. Collett-Solberg P. Congenital adrenal hyperplasia: from genetics and biochemistry to clinical practice, part I. Clin Pediatr. 2001;40(1):1-16
5. Speiser PW, Azziz R, Baskin LS, et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010;95(9):4133-4160
6. Nordenstrom A, Falhammar H. Management of endocrine disease: Diagnosis and management of the patient with non-classic CAH due to 21-hydroxylase deficiency. Eur J Endocrinol. 2019;180(3):R127-R145
7. Young WF Jr. Primary aldosteronism: A common and curable form of hypertension. Cardiol Rev. 1999;7(4):207-214
8. Young WF Jr. Pheochromocytoma and primary aldosteronism: diagnostic approaches. Endocrinol Metab Clin North Am. 1997;26(4):801-827
9. Wudy SA, Hartmann M, Svoboda M. Determination of 17-hydroxypregnenolone in plasma by stabile isotope dilution/benchtop liquid chromatography-tandem mass spectrometry. Horm Res. 2000;53(2):68-71
10. Therrell BL. Newborn screening for congenital adrenal hyperplasia. Endocrinol Metab Clin North Am. 2001;30(1):15-30
11. Bachega TA, Billerbeck AE, Marcondes JA, Madureira G, Arnhold IJ, Mendonca BB. Influence of different genotypes on 17-hydroxyprogesterone levels in patients with nonclassical congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Clin Endocrinol. 2000;52(5):601-607
12. Kao PC, Machacek DA, Magera MJ, Lacey JM, Rinaldo P. Diagnosis of adrenal cortical dysfunction by liquid chromatography-tandem mass spectrometry. Ann Clin Lab Sci. 2001;31(2):199-204
13. Young WF Jr. Management approaches to adrenal incidentalomas. A view from Rochester, Minnesota. Endocrinol Metab Clin North Am. 2000;29(1):159-185
14. Ibanez L, DiMartino-Nardi J, Potau N, Saenger P. Premature adrenarche-normal variant or forerunner of adult disease? Endocr Rev. 2000;21(6):671-696
15. Allolio B, Arlt W. DHEA treatment: myth or reality? Trends Endocrinol Metab. 2002;13(7):288-294
16. Lin CL, Wu TJ, Machacek DA, Jiang NS, Kao PC. Urinary free cortisol and cortisone determined by high performance liquid chromatography in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. 1997;82:151-155
17. Findling JW, Raff H. Diagnosis and differential diagnosis of Cushing's syndrome. Endocrinol Metab Clin North Am. 2001;30(3):729-747
18. Buchman Al. Side effects of corticosteroid therapy. J Clin Gastroenterol. 2001;33(4):289-297
18. Dodds HM, Taylor PJ, Cannell GR, Pond SM. A high-performance liquid chromatography-electrospray-tandem mass spectrometry analysis of cortisol and metabolites in placental perfusate. Anal Biochem. 1997;247(2):342-347
20. Cengiz H, Demirci T, Varim C, Cetin S. Establishing a new screening 17 hydroxyprogesterone cut-off value and evaluation of the reliability of the long intramuscular ACTH stimulation test in the diagnosis of nonclassical congenital adrenal hyperplasia. Eur Rev Med Pharmacol Sci. 2021;25(16):5235-5240. doi:10.26355/eurrev_202108_26537
Report Available
2 to 5 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | OK |
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)