Adrenocortical Function in Obesity and Cushing's Syndrome

1974 ◽  
Vol 47 (2) ◽  
pp. 119-129 ◽  
Author(s):  
Margaret E. Hankin ◽  
Helen M. Theile ◽  
A. W. Steinbeck
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Adrenocortical Function ◽  
Obese Women ◽  
Individual Values ◽  
Free Cortisol ◽  
Obese Subjects ◽  
The Mean ◽  
The Individual

1. The 24 h urinary excretions of Porter—Silber (P—S) chromogens, 17-hydroxycorticosteroids (17-OHCS) and free cortisol, and day-night variation of plasma P—S chromogens, were studied in normal and obese women and patients with a confirmed diagnosis of Cushing's syndrome. 2. The mean absolute values of P—S chromogens, 17-OHCS and free cortisol were similar for the normal and obese subjects and elevated in Cushing's syndrome. With the exception of the 17-OHCS there was some overlapping of the individual values within the three groups. All the subjects with Cushing's syndrome and several of the obese subjects had values of 17-OHCS which were outside the normal range. 3. The 24 h urinary 17-OHCS and free cortisol excretion expressed per kg body weight were significantly lower for the obese than for the control subjects and subjects with Cushing's syndrome. The values were significantly higher for the subjects with Cushing's syndrome than for the obese and normal subjects. There was some overlapping of the individual values. 4. Two normal and two obese subjects failed to show significant day-night variation, whereas only four of the patients with Cushing's syndrome had significant day-night variation of plasma P—S chromogens. 5. The urinary 17-OHCS for four of the obese subjects with some symptoms of adrenocortical hyperactivity were suppressed normally on a low dose of dexamethasone whereas those with Cushing's syndrome failed to do so.

GASCHROMATOGRAPHIC DETERMINATION OF STEROIDS IN THE URINE OF PATIENTS WITH CUSHING'S SYNDROME

1971 ◽  
Vol 67 (2) ◽  
pp. 303-315 ◽  
Author(s):  
A. J. Moolenaar ◽  
A. P. van Seters
Keyword(s):  
Liquid Chromatography ◽  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Diagnostic Value ◽  
Cushing's Syndrome ◽  
Gas Liquid Chromatography ◽  
Obese Subjects

ABSTRACT The 17-oxosteroids were estimated in the urine of 27 patients with Cushing's syndrome by gas-liquid chromatography (G. L. C.). The values of the various steroid fractions are compared with those of normal subjects, patients with thyrotoxicosis and obese subjects. The effect of the age of the patients on the diagnostic value of the invidual 17-oxosteroids and their ratios is discussed.

SKIN-FOLD THICKNESS IN NORMAL SUBJECTS AND IN PATIENTS WITH ACROMEGALY AND CUSHING'S SYNDROME

1969 ◽  
Vol 60 (4) ◽  
pp. 705-711 ◽  
Author(s):  
A. D. Wright ◽  
G. F. Joplin
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Normal Range ◽  
Clinical Method ◽  
Skin Fold Thickness ◽  
Skin Fold ◽  
Normal Mean ◽  
The Mean ◽  
Age And Sex

ABSTRACT A simple clinical method of determining the skin-fold thickness on the dorsum of the hand has been described using the Harpendon spring-loaded caliper. A normal range for age and sex has been established in 258 normal subjects. The mean skin-fold thickness was greater in men than in women, and in both decreased with age, falling from 2.85 to 1.75 mm in men, and from 2.65 to 1.60 mm in women (aged 15–20 to 70–80). In 48 acromegalic patients, 71 % of the skin-fold measurements were abnormally thick. In 12 patients with Cushing's syndrome, although all measurements were below the normal mean, 42 % only were abnormally thin.

A FOUR DAY CORTICOTROPHIN-SUPPRESSION TEST

1965 ◽  
Vol 48 (1) ◽  
pp. 147-162 ◽  
Author(s):  
Ingrid Ernest ◽  
Britt Håkansson
Keyword(s):  
Urinary Excretion ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenocortical Function ◽  
Menstrual Disorders ◽  
Day Range ◽  
Mental Disturbances ◽  
Suppression Test ◽  
The Mean ◽  
Obesity Hypertension

ABSTRACT A four day ACTH-suppression test was performed in 58 patients showing symptoms often associated with hypercorticism and in 25 cases of Cushing's syndrome. The non Cushing patients suffered from obesity, hypertension, plethora, diabetes and mental disturbances in various combinations and/or conditions related to hypertrichosis and menstrual disorders. Some of them also showed an increased basal excretion of 17-ketosteroids. Triamcinolone, in doses of 4 mg and 8 mg every six hours or 2 mg of dexamethasone every six hours, induced a good suppression of adrenocortical function in the non Cushing patients. This was demonstrated by chromatographic analysis of 24 different 24-hour urine samples collected on the third or fourth day of the test. In these cases – selected at random from the 58 non Cushing patients – the mean excretion of tetrahydroderivatives of cortisone and cortisol was < 0.3 mg/day (range 0.0–1.2 mg/day). Only traces of dehydroepiandrosterone and 11-oxy-17-ketosteroids were found. In all cases, 17-ketogenic steroids, Porter-Silber chromogens and 17-ketosteroids were determined by routine methods and the results are discussed with regard to the presence of non specific chromogens. There was no difference in the urinary excretion of steroids during the administration of 16 mg and 32 mg respectively of triamcinolone and of 8 mg of dexamethasone daily. In 9 of 11 cases of non-tumourous Cushing's syndrome, triamcinolone in a dose of 4 mg every six hours did not suppress the urinary excretion of 17-ketogenic steroids, Porter-Silber chromogens or 17-ketosteroids normally. In two cases, however, there was a normal suppression according to the criteria chosen. In one case of non-tumourous Cushing's syndrome, suppression could not be demonstrated during the administration of triamcinolone in a dose of 16 mg every six hours for four days. Because of the varying degrees of suppression found in Cushing's syndrome, the diagnostic conclusions drawn from the ACTH-suppression test should be made with caution. Marked variation in the basal excretion of steroids adds to the difficulties as do the limitations of the test imposed by unspecificity of the methods used in evaluating the adrenocortical function.

Measurement of urinary free 20 alpha-dihydrocortisol in biochemical diagnosis of chronic hypercorticoidism.

1986 ◽  
Vol 32 (5) ◽  
pp. 808-810 ◽  
Author(s):  
M Schöneshöfer ◽  
B Weber ◽  
W Oelkers ◽  
K Nahoul ◽  
F Mantero
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Values ◽  
Excretion Rate ◽  
Normal Subjects ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Normal Range ◽  
Free Cortisol ◽  
Adrenal Secretion ◽  
Stimulation Of

Abstract Using liquid chromatography, we estimated the urinary excretion of 20 alpha-dihydrocortisol (20-DH) and urinary free cortisol (UFC) in normal subjects and in 40 patients with Cushing's syndrome of different etiologies. The median normal excretion rate (nmol/24 h) was 174 for 20-DH and 68 for UFC, the 20-DH/UFC ratio thus being 2.55. For patients with Cushing's syndrome, the excretion rate was 1798 for 20-DH and 298 for UFC, the ratio 6.03. We evaluated the effect of acute stimulation of adrenal secretion on 20-DH and UFC by administering corticotropin to six normal subjects. After such stimulation, the excretion rate was 566 for 20-DH and 1238 for UFC (ratio 0.45). Whereas 20-DH excretion rate exceeded the normal range in all patients, six patients had normal or even below-normal values for UFC excretion. Evidently, measurement of urinary 20-DH is a better test for chronic hypercorticoidism than is measurement of urinary UFC, and chronic hypercorticoidism can be differentiated from the acute state by the 20-DH/UFC ratio.

Cortisol and Aldosterone Excretion and Plasma Cortisol Concentrations in Normal and Obese Female Subjects

1972 ◽  
Vol 43 (2) ◽  
pp. 289-298 ◽  
Author(s):  
Margaret E. Hankin ◽  
Helen M. Theile ◽  
A. W. Steinbeck
Keyword(s):  
Plasma Cortisol ◽  
Adrenocortical Function ◽  
Adrenocortical Activity ◽  
Obese Female ◽  
Free Cortisol ◽  
Derivative Method ◽  
Obese Subjects ◽  
The Mean ◽  
And Control ◽  
Double Isotope

1. The 24 h urinary excretion of free cortisol and aldosterone-18-glucuronide has been studied in twenty-three control and twenty-three grossly obese subjects by a double-isotope-dilution derivative method. 2. Day-night variation of plasma and urinary cortisol has also been investigated. 3. The mean absolute steroid values were similar for the obese and non-obese subjects. 4. The 24 h urinary values for free cortisol expressed as μg/kg of body weight were significantly higher for the controls. 5. The majority of the obese and control subjects had a day-night variation of plasma cortisol. All subjects, with two exceptions, showed day-night variation of free cortisol in the urine. 6. It is suggested that the estimation of unconjugated cortisol in timed urinary collections could be useful for investigations of adrenocortical function. 7. The findings do not support the presence of increased adrenocortical activity in developed obesity.

scholarly journals Urinary Free 11-Hydroxycorticosteroid/Creatinine Ratios in Early Morning Urine Samples as an Index of Adrenal Function

1977 ◽  
Vol 14 (1-6) ◽  
pp. 203-206 ◽  
Author(s):  
Michael S. Walker
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Early Morning ◽  
Cushing's Syndrome ◽  
Urine Samples ◽  
Creatinine Ratio ◽  
Laboratory Staff ◽  
The Mean ◽  
Age Range ◽  
Normal Laboratory

Urinary free 11-hydroxycorticosteroid/creatinine ratios were determined in early morning urine samples from 113 females (age range 20–45 years) and 65 males (age range 22–45 years). Basal values in normal subjects fluctuated between 5 and 55 μmol/mol creatinine. In four patients in whom Cushing's syndrome was diagnosed, urinary free 11-hydroxycorticosteroid/creatinine ratios were greater than 85 μmol/mol creatinine. Administration of dexamethasone (0.5 mg/q.i.d.) to nine normal laboratory staff for two days resulted in a suppression of the urinary free 11-hydroxycorticosteroid/creatinine ratio to less than 50% of the mean basal value in all cases. This degree of suppression did not occur in two cases of Cushing's syndrome due to adrenal tumours.

scholarly journals Cushing’s Syndrome during Pregnancy: Post Delivery Adrenalectomy Consequent to Medical Management without Adrenal Enzyme Inhibitors

2012 ◽  
Vol 1 (1) ◽  
pp. 38-41
Author(s):  
Fatemeh Esfahanian ◽  
Firoozeh Faiz ◽  
Mohammad Mahdi Zamani ◽  
Sedigheh Hantoushzadeh
Keyword(s):  
Cushing’S Syndrome ◽  
Enzyme Inhibitors ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Adrenocortical Function ◽  
Adrenocortical Adenoma ◽  
Free Cortisol ◽  
Contrast Magnetic Resonance ◽  
Suppression Test ◽  
Magnetic Resonance Imaging Mri

A 32-year-old female, gravid two, para one, with Cushing’s syndrome (CS) was admitted to our hospital at 25 week of gestation with severe hypercortisolism. Basal urinary free cortisol (UFC) was elevated about 10 times above the upper limit of normal in two separate times and plasma cortisol failed to suppress after an overnight 1mg dexamethasone suppression test but Adrenocorticotropic hormone (ACTH) level was suppressed. An abdominal non-contrast magnetic resonance imaging (MRI) disclosed a 3-cm right adrenal mass (Fig. 1). Due to her critical general condition, the adrenalectomy was not performed. At 30 week of gestation, by the diagnosis of severe preeclampsia she underwent an emergent cesarean section. Two weeks later, right adrenalectomy was performed via laparotomy. Pathologic examination of the gland showed a benign adrenocortical adenoma. The newborn was a healthy male who weighed 1850 gram. There was no clinical or biochemical suppression of adrenocortical function in child and they were discharged after 40 days.[GMJ. 2012;1(1):38-41]

Abnormalities of endocrine function in patients with clinically "silent" adrenal masses

1995 ◽  
Vol 132 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Bruno Ambrosi ◽  
Susanna Peverelli ◽  
Elena Passini ◽  
Tiziana Re ◽  
Riccardo Ferrario ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Endocrine Function ◽  
Type I ◽  
Unilateral Adrenalectomy ◽  
Free Cortisol ◽  
Adrenal Masses ◽  
Cortisol Levels ◽  
Secondary Hypoadrenalism

Ambrosi B, Peverelli S, Passini E, Re T, Ferrario R, Colombo P, Sartorio A, Faglia G. Abnormalities of endocrine function in patients with clinically "silent" adrenal masses. Eur J Endocrinol 1995;132:422–8. ISSN 0804–4643 Because, in recent years, patients with incidentally discovered adrenal masses have been encountered increasingly, their endocrine function was investigated in basal conditions and after dynamic tests. Thirty-two patients (23 women and 9 men, aged 28–74 years) were studied. Lesion diameter, as documented by computed tomography and/or nuclear magnetic resonance imaging, ranged between 5 and 65 mm; the tumors were localized on the right in 22 patients, on the left in 5 and bilaterally in 5 cases. In basal conditions, urinary free cortisol (UFC) excretion, plasma adrenocorticotropin (ACTH) and cortisol levels were normal, except for 4 patients who showed high UFC and ACTH levels in the low–normal range. Ovine corticotropin-releasing hormone (CRH, 1 μg/kg iv) was given to 18 patients, inducing normal ACTH and cortisol responses in 12, blunted responses in 4 and no response in 2 cases. No reduction in ACTH and cortisol levels after suppression tests was observed in 4 of 29 patients after dexamethasone (1 mg overnight) or in 6 of 29 after loperamide. The 4 patients who were unresponsive to both tests did not show any further inhibition after high-dose dexamethasone administration, had low plasma ACTH levels and showed impaired or absent responses to the CRH test: they were diagnosed as affected with preclinical Cushing's syndrome. An exogenous ACTH test performed in 30 patients caused a normal cortisol rise. Basal mean 17-hydroxyprogesterone (17-OHP) levels were not different from those in normal subjects. After ACTH the 17-OHP rate increase was higher than in normal subjects (17-OHP(30–)/30 min = 0.31 ±0.04 vs 0.07 ± 0.01 nmol·1−1·min−1; mean±SEM, p < 0.01); in particular, this parameter was elevated in 18 of 30 patients (17-OHP(30–0)/30 min range = 0.23–1.07 vs 0.01–0.19 nmol·1−1·min−1 in normal subjects). In a subset of 11 patients, serum markers of bone (bone-GLA protein (BGP) and carboxyterminal cross-linked telopeptide of type I collagen (ICTP) and collagen turnover (aminoterminal propeptide of type III procollagen (PIIINP)) were significantly (p < 0.01) lower than in normal subjects: in particular, in 2 preclinical Cushing's patients they were markedly reduced and rose after unilateral adrenalectomy. Of these 2 patients who underwent surgery, 1 showed a secondary hypoadrenalism. The histological study in 7 operated patients revealed the presence of benign adenoma in 4 cases and carcinoma, myelolipoma and hematoma in the others. In conclusion, in patients with incidentalomas endocrine testing is recommended because about two-thirds of them show subtle signs of adrenal overactivity. In patients with enzymatic defects of steroidogenesis a surgical approach is not suggested. On the contrary, the existence of a preclinical Cushing's syndrome has to be investigated carefully and followed up in order to disclose the possible appearance of clinical and/or metabolic features induced by the hypercortisolism and to suggest a surgical treatment. B Ambrosi, Institute of Endocrine Sciences, Ospedale Maggiore, IRCCS, via F Sforza 35, 20122 Milan, Italy

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