Adrenocortical Function in Old Age: Response to Acute Adrenocorticotropin Stimulation*

Abstract

To elucidate the controversial point whether, in analogy with Δ⁵-steroid secretion, adrenal Δ⁴-steroid secretion is significantly decreased in elderly persons, we studied the response of plasma levels of both Δ⁵-steroids (dehydroepiandrosterone, 17-hydroxypregnenolone, and pregnenolone) and Δ⁴-steroids (cortisol, androstenedione, 17-hydroxyprogesterone, and progesterone) to acute ACTH stimulation in four groups of young and elderly males and females, respectively. To study the possible influence of sex hormones on adrenocortical function in elderly persons, we performed the same study in males with prostatic carcinoma treated with estrogens. The data show that in elderly persons, the response of plasma Δ⁴-steroids to ACTH stimulation is comparable or higher than that in young subjects, whereas the response of Δ⁵-steroids is significantly decreased; estrogen treatment does not change this pattern. It is concluded that in elderly persons adrenal Δ⁴-steroid secretory capacity is unimpaired, whereas Δ⁵-steroid secretion is significantly decreased. The responsible mechanism remains to be elucidated.