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Introduction ⬇

Pregnanetriol is a ketogenic steroid reflecting one segment of adrenocortical activity. Pregnanetriol should not be confused with pregnanediol despite the similarity of name. This 24-hour urine test is done to diagnose congenital adrenal hyperplasia, adrenogenital syndrome, owing to a defect in 21-hydroxylation. The diagnosis of adrenogenital syndrome is indicated in:

  1. Adult women who show signs and symptoms of excessive androgen production with or without hypertension.

  2. Craving for salt.

  3. Sexual precocity in boys.

  4. Infants who exhibit signs of failure to thrive.

  5. Presence of external genitalia in females (pseudohermaphroditism). In males, differentiation must be made between a virilizing tumor of the adrenal gland, neurogenic and constitutional types of sexual precocity, and interstitial cell tumor of the testes.

Normal Findings ⬆ ⬇

Adult female: 0–1.4 mg/24 hr or 0–4.2 μmol/d

Adult male: 0. 2–2 mg/24 hr or 0.6–5.9 μmol/d

Child (6–9 years old): <0.3 mg/24 hr or <0.9 μmol/d

Child (10–16 years old): 0.1–0.6 mg/24 hr or 0.3–1.8 μmol/d

Procedure ⬆ ⬇

  1. Properly label a 24-hour urine container with the patient’s name, date and time of collection, and test(s) ordered.

  2. Refrigerate the specimen if necessary; some laboratories may require a boric acid preservative in the collection receptacle.

  3. Follow general instructions for 24-hour urine collection (see Long-Term, Timed Urine Specimen [2-Hour, 24-Hour]).

  4. Record exact starting and ending times on the specimen container and in the patient’s healthcare record.

  5. Send the completed specimen to the laboratory.

Clinical Implications ⬆ ⬇

  1. Elevated urine pregnanetriol occurs in:

    1. Congenital adrenocortical hyperplasia

    2. Stein–Leventhal syndrome

    3. Ovarian and adrenal tumors

  2. Decreased urine pregnanetriol occurs in:

    1. Hydroxylase deficiency (rare)

    2. Ovarian failure

Interventions ⬆

Pretest Patient Care

  1. Explain purpose of test, procedure for 24-hour urine collection, and interfering factors. Written instructions can be helpful.

  2. Allow food and fluids.

  3. Avoid muscular exercise before and during specimen collection.

  4. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel patient regarding abnormal findings.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.