“STEROID DIABETES” AND ALKALOSIS ASSOCIATED WITH CUSHING'S SYNDROME: REPORT OF CASE, ISOLATION OF 17-HYDROXY-CORTICOSTERONE (COMPOUND F) FROM URINE, AND METABOLIC STUDIES*

Abstract

A case of Cushing''s syndrome in a boy, aged 15 yrs., is reported primarily because of the presence of diabetes of unusual severity which had the characteristics of steroid diabetes produced in animals by the admn. of large doses of carbohydrate-active adrenal steroids or by stimulation of the adrenals by adrenocorticotrophic hormone.. In this case the urinary excretion of corticosteroids was markedly increased, and 17-hydroxycorticosterone (compound F) was isolated from the urine in considerable quantities. The diabetes in this case was presumably due to the production of large amts. of compound F by hypertrophic, hyperplastic adrenal cortices, as it had the same general characteristics as the diabetes induced in animals by the admn. of large amts. of compound F or related steroid hormones; namely, insensitivity to insulin, mildness during fasting, and negative N balance in the absence of much glycosuria. Necropsy revealed, in addition to hypertrophic and hyperplastic adrenal cortices, a small thymoma and a parathyroid adenoma. The evidence indicates that the latter 2 lesions did not play any primary role in the pathogenesis of the syndrome. The possibil- ity that all of the features of Cushing''s syndrome in this case, including the alkalosis, might have been due to overproduction of compound F by hyperplastic adrenal cortices, is discussed briefly.