THE EFFECT OF ADRENOCORTICOTROPHIC HORMONE IN CONGENITAL ADRENAL HYPERPLASIA WITH VIRILISM AND IN CUSHING'S SYNDROME TREATED WITH METHYL TESTOSTERONE 1

Abstract

One case of Cushing''s syndrome and 2 cases of congenital adrenal hyperplasia with virilism were placed on a constant diet and treated with 200 mg. of adrenocorticotrophic hormone (ACTH) over a 24-hr. period. The Cushing''s syndrome showed a rise in urinary excretion of 17-ketosteroid and 11-oxysteroid. There was a polymorphonuclear leukocytosis and decrease in eosinophils. There was a 40 mg% rise in the fasting blood sugar and a fall in the R. Q. from 0.85 to 0.76. There was a K diuresis and a retention of Na and Cl which persisted for 48 hrs. The normal response to ACTH suggests that the adrenal rather than the pituitary may be responsible for the metabolic disturbance in this case. In the cases of adrenal hyperplasia the 17-ketosteroids were high but rose further with treatment. The 11-oxysteroids showed a slight rise. There was a polymorphonuclear leukocytosis but no fall in eosinophils. There was a moderate drop in respiratory quotient but no rise in blood sugar. The remarkable finding was a Na and Cl diuresis with loss in wt. In one case the daily Na excretion rose from 140 to 470 meq. It is thought that this represents the first clear example of a trophic hormone producing qualitatively different effects on the same gland. The Na loss might be due to a 17-hydroxycorticosterone which promotes Na excretion, and may explain the occurrence of Addisonian crises in adrenal hyperplasia.