The Transport and Excretion of Uric Acid in Man. V. A Sex Difference in Urate Metabolism: With a Note on Clinical and Laboratory Findings in Gouty Women*

RECENT studies have tended to confirm the long suspected importance of the sex endocrines in gout (1, 2, 3, 4). Smyth, Cotterman and Freyberg (1) found that male relatives of gout patients who inherit asymptomatic hyperuricemia do not usually develop abnormally elevated plasma urate levels until after puberty. Stecher, Hersh, and Solomon (2) demonstrated that female carriers of this gene generally do not develop abnormally elevated plasma urate levels until the menopause, or the period of failing ovarian function which precedes the menopause. Because some years of hyperuricemia generally precede the onset of clinical symptoms, clinical gout follows a similar pattern, but at an interval of some years. Clinical gout in men seldom appears before puberty. In women symptoms ordinarily first occur after the menopause. Exceptionally, women do develop gout well before the menopause, possibly because of special hereditary factors (see addendum regarding gout in women). Hill (5) pointed out that in women with premenopausal gout, attacks of acute gouty arthritis tended to occur at the menses, the low point of estrogen secretion in the menstrual cycle.1 Since the time of Hippocrates, gout has been reputed to be particularly infrequent in eunuchs, but this question does not appear to have been studied critically.