17-ketosteroids in the urine indicate which of the following?

The presence of 17-ketosteroids in the urine is indicative of increased androgen production that typically occurs when there is an excess of adrenal steroid hormones. Specifically, 17-ketosteroids are metabolites of androgens such as testosterone and androstenedione, which are produced from the adrenal cortex.

Decreased levels of 17-hydroxylase, which is an enzyme involved in steroidogenesis, lead to reduced conversion of pregnenolone and progesterone into cortisol and sex hormones. This condition can lead to an accumulation of androgens, resulting in an increase in 17-ketosteroids as more of these androgen metabolic end products are excreted. Therefore, when 17-ketosteroids are elevated in urine, it reflects an alteration in the steroidogenic pathway attributable to insufficient activity of 17-hydroxylase.

In contrast, increased levels of 11-hydroxylase or 17-hydroxylase would lead to a different steroid profile; specifically, an increase in the production of glucocorticoids or another class of steroids, which would not typically manifest as an increase in 17-ketosteroids. Meanwhile, decreased activity of 21-hydroxylase is