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Research 17-OH Progesterone
Endocrinology

17-OH Progesterone

Optimal Result: 35 - 290 ng/dL.

17-OHP is produced by the adrenal gland as part of the process of making the important hormone cortisol.

What are the adrenal glands?

These are two small glands. One is located on top of each kidney. Along with special enzymes, or proteins, 17-OH progesterone is converted to a hormone called cortisol.

Function of cortisol:

Cortisol is constantly released in varying amounts, but high levels are released during times of physical or emotional stress. Cortisol is also important in regulating metabolism and the immune system.

Cause and effect of Process interruption:

A cortisol deficiency can occur in people who lack the appropriate enzymes, which can lead to a buildup of 17-OH progesterone in the blood.

Several enzymes are required for this process. If a person is born with either not enough of one of these enzymes or an abnormal form of an enzyme, their adrenal gland cannot produce cortisol efficiently. Depending on which enzyme is abnormal, another important hormone, aldosterone may also be affected. In such cases, 17-OHP builds up. Some of the excess 17-OHP is used up by making male hormones (androgens). Excess androgens can cause the development of male sexual characteristics, in both females and young males.

These inherited enzyme deficiencies and the resulting excess androgens occur in a group of disorders called congenital adrenal hyperplasia (CAH).

More on CAH?

CAH can occur in both boys and girls. Young children with CAH may have ambiguous genitalia, pubic hair, or acne. The condition can also develop later in life in less obvious ways. Some common symptoms include clearly defined muscle tone, increased body hair, and a deeper voice.

In infants, CAH can sometimes cause dehydration or shock, both of which are very serious conditions. As a result, the 17-OH progesterone test should be part of every newborn’s initial medical examination.

Most cases of CAH are caused by a lack of the enzyme 21-hydroxylase. In more severe forms of CAH, the condition becomes evident in infancy or childhood, while milder forms, known as late-onset or non-classical CAH, may not become evident until later in life, including adulthood.

When to perform a 17-OH progesterone test? 

A doctor will usually order a 17-OH progesterone test for a young child, teenager, or adult who displays some of the classic symptoms of CAH. The sooner a person with CAH is diagnosed and treated, the less likely they are to experience complications.

Interpretation of the test results?

The results of a 17-OH progesterone test depend on many variables, including age, sex, and testing methods. This can make it difficult to identify normal and abnormal test results. Make sure to meet with the doctor to discuss what the 17-OH progesterone test results mean for you or your child.

In general, normal results for various age groups include:

  • newborns: 1,000-3,000 nanograms/deciliter (ng/dL)
  • babies older than 24 hours: less than 100 ng/dL
  • adults: less than 200 ng/dL

References

  • Fritz MA, Speroff L. Normal and abnormal sexual development. In: Speroff L, Fritz MA, eds. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011:chap 9.
  • Lambert SM, Vilain EJ, Kolon TF. A practical approach to ambiguous genitalia in the newborn period. Urol Clin North Am. 2010; 37(2):195-205.
  • Mark T. Endocrinology. In: Engorn B, Flerlage J, eds. Johns Hopkins: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 10.
  • White PC. Congenital adrenal hyperplasia and related disorders. In: Kliegman RM, Bonita F, Stanton MD, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 576.

What does it mean if your 17-OH Progesterone result is too high?

What do high levels mean?

High levels of 17-OH progesterone in the blood may indicate CAH. Infants with CAH tend to have 17-OH progesterone levels ranging from 2,000 to 4,000 ng/dL, while adults with CAH usually have 17-OH progesterone levels above 200 ng/dL.

High 17-OH progesterone levels could also indicate the presence of an adrenal tumor, which can also affect hormone levels. Further testing may be required to determine the specific cause of increased CAH levels.

What does it mean if your 17-OH Progesterone result is too low?

Understanding 17-OH Progesterone:

- What is 17-OH Progesterone? 17-OH Progesterone, or 17-Hydroxyprogesterone, is a steroid hormone produced by the adrenal glands and the ovaries. It's a precursor in the synthesis of cortisol and androgenic hormones. Its levels can provide valuable information about the functioning of these glands and the body's hormone balance.

- Why is it Important? The measurement of 17-OH Progesterone is crucial for diagnosing and managing conditions related to adrenal and ovarian function. One of the most common reasons for testing 17-OH Progesterone levels is to diagnose congenital adrenal hyperplasia (CAH), a group of genetic disorders affecting the adrenal glands. These disorders can lead to abnormalities in cortisol and androgen levels, affecting growth, development, and metabolism.

Reference intervals for adult females:

Follicular: 15 - 70 ng/dl

Luteal: 35 - 290 ng/dl

17-OH Progesterone and female cycles:

The levels of 17-OH Progesterone in females can vary significantly depending on the phase of the menstrual cycle, reflecting the complex interplay of hormones that regulate menstrual and reproductive functions. During the follicular phase, which occurs from the start of menstruation until ovulation (roughly days 1-14 of a typical 28-day cycle), levels of 17-OH Progesterone are generally lower. This is because this phase is characterized by the maturation of follicles in the ovaries, leading up to the release of an egg. In contrast, during the luteal phase, which follows ovulation and lasts until the onset of menstruation (approximately days 15-28 of the cycle), levels of 17-OH Progesterone increase significantly. This rise is due to the formation of the corpus luteum, a temporary endocrine structure that secretes progesterone to prepare the uterine lining for a potential pregnancy. If fertilization does not occur, the corpus luteum degenerates, leading to a decrease in progesterone and 17-OH Progesterone levels, eventually resulting in menstruation. Understanding these fluctuations is crucial for interpreting the results of hormone tests accurately and can provide valuable insights into a woman's ovulatory status and overall reproductive health.

What do low levels mean?

Decreased levels of 17-OH Progesterone can provide important clues about a person's health status, though it's crucial to interpret these levels within the broader context of other test results and clinical symptoms. Let's explore what decreased levels might indicate and why they're significant:

→ Adrenal Insufficiency

One of the primary concerns when 17-OH Progesterone levels are low is adrenal insufficiency, a condition where the adrenal glands do not produce adequate amounts of steroid hormones, including cortisol and aldosterone. This condition can lead to symptoms such as fatigue, muscle weakness, weight loss, low blood pressure, and sometimes darkening of the skin.

→ Ovarian Factors

For women, low levels of 17-OH Progesterone might also reflect issues related to ovarian function. Since the ovaries produce this hormone as part of the menstrual cycle, significantly low levels could indicate potential problems with ovulation or ovarian reserve. However, it's essential to correlate these levels with other hormone tests and clinical findings for a comprehensive understanding.

→ Impact on Fertility

In the context of fertility, decreased 17-OH Progesterone levels might suggest insufficient corpus luteum function. The corpus luteum is responsible for producing progesterone in the second half of the menstrual cycle, essential for preparing the uterine lining for a potential pregnancy. Low levels could therefore impact fertility and pregnancy outcomes.

Other Considerations:

→ Non-Classical Adrenal Hyperplasia: While much attention is given to elevated levels of 17-OH Progesterone in diagnosing conditions like congenital adrenal hyperplasia (CAH), significantly low levels, particularly when symptoms of adrenal dysfunction are present, warrant further investigation to rule out other forms of adrenal pathology.

→ Age and Phase of Menstrual Cycle: It's important to note that normal ranges for 17-OH Progesterone can vary based on age and, in females, the phase of the menstrual cycle. Therefore, what might be considered low in one context could be normal in another.

Decreased 17-OH Progesterone levels should always be interpreted within the broader context of a patient's overall health, symptoms, and other laboratory findings. A comprehensive evaluation, often involving additional tests and clinical assessment, is necessary to understand the implications fully.

While decreased levels of 17-OH Progesterone can hint at various health issues, including adrenal insufficiency and potential reproductive concerns, diagnosing and understanding the implications of these levels require a holistic approach to patient care. If low levels are detected, further evaluation by a healthcare provider is crucial to determine the underlying cause and appropriate management strategy.

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