ADRENAL RESPONSE TO ACTH IN VARIOUS CLINICAL CONDITIONS

Abstract

In the course of the 48-hr. ACTH test, the following detns. were made in 27 patients: urinary 17-ketosteroids, formaldehydogenic corticoids, uric acid/ creatinine ratio (U/C) and total blood eosinophils. Of these, the formaldehydrogenic corticoid value was the most sensitive index of adrenal responsiveness. Occasionally, when one of the detns. was indicative of a good response, the others showed no change. The U/C value rose in less than 50% of the positive reactions obtained. In panhypopituitarism, the result of the 4-hr. ACTH test was negative, whereas the result of the 48-hr. test was positive. In 2 patients with thyroid myxedema, the adrenal responsiveness was similar to that seen in pituitary failure, rather than in primary adrenal failure. In patients with chronic illness or advanced mammary cancer, there was a significant increase in urinary formaldehydogenic corticoids, but little, if any, in the 17-ketosteroids. This change in adrenal responsiveness was also seen in normal elderly women. Detns. in a normal man, with and without ACTH admn., suggested that the adrenal response is probably not due to the exogenous ACTH alone. The 48-hr. ACTH test has definite clinical usefulness and, when indicated, should be employed in determining the responsiveness of the adrenal cortex.