Quantitative Determination of the Urinary Cortisolc Metabolites, “Tetrahydro F,” “Allo-Tetrahydro F” and “Tetrahydro E”: Effects of Adrenocorticotropin and Complex Trauma in the Human1

Abstract

Several metabolites of cortisol (F) were quantified in the urine of subjects administered adrenocortico-tropin (ACTH) and F. Similar studies were made with patients undergoing complex trauma. An increase in both the rate of excretion of each metabolite, 3[alpha], 11[beta], 17[alpha], 21-tetrahydroxypregnan-20-one (THF), 3[alpha], 11[beta], 17[alpha], 21-tetrahydroxyallopregnan-20-one (allo-THF) and 3[alpha], 17[alpha],21-trihydroxypregnan-ll,20-dione (THE) and the ratio of urinary THF to THE occurred (a) during surgery; (b) after the intravenous administration of ACTH to normal subjects; (c) after the intravenous administration of F; (d) after severe burn. In addition to the above alterations in urinary metabolites allo-THF was not detected during a severe surgical episode but reappeared upon convalescence. In 3 fatal burn cases the ratio of THF to THE rose to extremely high values prior to death, suggesting the presence of factors which limit the conversion of F to THE. There was no indication that the formation of allo-THF was grossly altered in the burns. In one of the latter the intravenous administration of large amounts of F led to no change in the THE excreted but did increase the daily excretion of THF and allo-THF. It is suggested that trauma leads to variations in the overall metabolism of F.