URINARY DEHYDROISOANDROSTERONE IN HYPERADRENOCORTICISM: INFLUENCE OF CORTISONE, HYDROCORTISONE AND ACTH*

Abstract

INTRODUCTION THIS paper deals with a comparison of studies made on 4 patients with adrenocortical tumors, 6 patients with congenital adrenal hyperplasia and 1 patient with postnatal adrenal hyperplasia. The observations include a) spectrophotometric curves of a colorimetric reaction for dehydroisoandrosterone performed on urinary extracts (1), b) measurement of the total amounts of 17-ketosteroids and dehydroisoandrosterone-like steroids (DHIA steroids) excreted, and c) effects of cortisone and ACTH on the excretion of the various groups of urinary steroids which were measured. In 1936 Callow isolated dehydroisoandrosterone as the prominent urinary steroid in a ase of virilizing adrenocortial tumor (2). Talbot, Butler and MacLachlan in 1940 found by digitonin precipitation that urinary excretion of the 3-beta-hydroxy-17-ketosteroids was abnormally inreased in children with virilizing adrenocortical tumor (3). These studies have since been repeatedly confirmed (4–7). There appeared to be no simple, colorimetric way of differentiating between the 3-alpha-hydroxy and 3-beta-hydroxy urinary 17-ketosteroids until Dirscherl and Zilliken discovered that pure dehydroisoandrosterone gave a blue color on treatment with concentrated sulfuric acid and dilution with water (8). Subsequently several workers have adapted this of reaction for use with urine extracts, since it clearly distinguishes dehydroisoandrosterone from androsterone (1, 9, 10). Allen and colleagues have prepared spectrophotometric curves from patients with virilizing adrenocortical tumor, adrenocortical hyperplasia and Cushing's syndrome, using a variation of this colorimetric procedure (1). These workers found that there were striking differences between the spectrophotometric curves of patients with virilizing adrenocortical tumor and those with adrenocortical hyperplasia or Cushing's syndrome.