QUANTITATIVE ESTIMATION OF ADRENOCORTICAL HORMONES AND THEIR α-KETOLIC METABOLITES IN URINE

Abstract

Urinary corticosteroid patterns were estimated in patients with hyper-adrenocorticism including Cushing''s syndrome, adrenogenital syndrome and Conn''s syndrome. The patterns reflect excessive hormone production. The increased secretion of precursors and altered metabolism of cortisol (F) and corticosterone (B) in such a characteristic way aid in differential diagnosis. In Cushing''s disease (bilateral adrenocortical hyperplasia) the patterns indicate a hyper-secretion of cortisol and its immediate precursor Reichstein''s S. All other hormones and precursors are produced in essentially normal amounts. The metabolic pathway of cortisol and corticosterone is shifted in favor of tetrahydrocortisol (THF) and tetrahydrocortico-sterone (THB) respectively, at the cost of allotetrahydrocortisol (allo-THF) and tetrahydrocortisone (THE), allotetrahydrocorticosterone (allo-THB) and tetrahydro-11-dehydrocorticosterone (THA) respectively. In adrenocortical carcinoma the undue loss of precursors (Reichstein''s S and possibly 17-hydroxyprogesterone) seems to be an essential feature, irrespective whether cortisol or androgens are produced in abnormally large amounts. The excretion of tetrahydro-11-deoxycortisol (THS) particularly may be used to differentiate between adrenal hyperplasia and carcinoma.