Changes in Urinary Steroid Excretion and Correlated Metabolic Effects During Prolonged Administration of Adrenocorticotropic Hormone in Man

Abstract

Adrenocorticotrophic (ACTH) hormone was given to a 46-yr. old cf with an expanding lesion of the sella turcica which was arrested by roentgen therapy. The subject had a moderate secondary adrenocorti-cal insufficiency, which would accentuate any adrenotrophic response to the pituitary hormone. ACTH was prepared from hog pituitary glands and contained the equivalent of 0.12 unit of oxtocic activity/mg.; growth-promoting, gona-dotrophic, and thyrotrophic factors were not present in significant amts. The patient was maintained on a constant diet and was given intramusc. injns. of 10 mg. of ACTH every 6 hrs. for 6 days. There was a 7-fold increase in the daily excretion of " 11-oxysteroids", and accompanying 5-fold increase in the 17-ketosteroid excretion, an increase of 58% in the daily urinary output of total N, with a rise in the excretion of uric acid. Urinary creatinine remained constant. Na excretion was markedly decreased. The increase in the excretion of "11-oxysteroids" is definite evidence of increased adrenocortical activity under the action of ACTH. The rise in 17-ketosteroid output to as high as 12.2 mg./day indicates that the major part of this material was derived from the adrenal cortex. The increased N excretion parallels that of the "11-oxysteroids", which promote the catabolism of body protein, whereas the Na retention suggests the elaboration of a desoxycorticosterone-like subst. From the close correlation between the changes in urinary excretion of steroids, N, and uric acid, the ratio of uric acid to creatinine may be regarded as a measure of increased adrenal cortex activity during stimulation.