STEROID EXCRETION AND PLASMA CORTISOL IN 41 CASES OF CUSHING'S SYNDROME

1966 ◽  
Vol 51 (4) ◽  
pp. 511-525 ◽  
Author(s):  
Ingrid Ernest
Keyword(s):  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Similar Data ◽  
Control Material ◽  
Present Material ◽  
Control Range ◽  
The Mean ◽  
Obesity Hypertension ◽  
Steroid Excretion

ABSTRACT Urinary excretion of 17-hydroxycorticosteroids (17-OHCS) and of Porter-Silber chromogens as well as plasma cortisol at different times of the day were measured repeatedly in 41 cases of Cushing's syndrome and the results were compared with similar data from 55 non Cushing patients suffering from obesity, hypertension and other symptoms often associated with Cushing's syndrome. The Cushing patients showed a marked variation in steroid output and in many cases the excretion was within the control range during one or several days. In only four of all patients, however, did the mean excretion of 17-OHCS overlap with that found in the control material. There was a marked overlapping between the Cushing and the non Cushing patients with respect to plasma cortisol. At midnight, however, most Cushing patients (34/36) at repeated determinations showed one or several figures higher than those of the control material. In the present material there was a marked overlapping between the Cushing (15 cases) and the non Cushing patients (14 cases) with respect to the increase in steroid excretion after intravenously administered corticotrophin (ACTH). In 14 cases of Cushing's syndrome due to hyperplasia the administration of metapyron caused an increase in steroid excretion. One such case failed to react to metapyron as did 3 cases of cortisol producing tumours.

ORAL AND INTRAVENOUS SUPPRESSION TESTS IN THE DIAGNOSIS OF CUSHING'S SYNDROME

1965 ◽  
Vol 33 (3) ◽  
pp. 515-524 ◽  
Author(s):  
V. H. T. JAMES ◽  
J. LANDON ◽  
V. WYNN
Keyword(s):  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Early Period ◽  
Cushing's Syndrome ◽  
Adrenal Hyperplasia ◽  
Adrenal Tumour ◽  
Bilateral Adrenal Hyperplasia ◽  
Steroid Excretion ◽  
Synthetic Glucocorticoids ◽  
Urinary Steroid

SUMMARY Adrenocortical suppression tests, based on the fall in urinary 17-hydroxy-corticosteroid excretion during the oral administration of dexamethasone, were found to be of value in the diagnosis of Cushing's syndrome, but less useful in differentiating bilateral adrenal hyperplasia from adrenal tumour. Such tests have the disadvantage of requiring accurate urine collections and of taking several days to perform. A test is described, based on the decrease in plasma cortisol concentration during i.v. infusion of dexamethasone at a rate of 1 mg./hr. The results obtained in 12 patients with Cushing's syndrome and bilateral adrenal hyperplasia differed from those found in control subjects in that there was a delay between the start of the infusion and the fall of plasma cortisol, and the rate of fall was less rapid. The values found after 180 min., expressed either as μg./100 ml. or as a percentage of the resting level, differed significantly (P < 0·001) in the two groups. The test proved valuable as an aid to the diagnosis of Cushing's syndrome, was easy to perform, and could be completed in 3 hr. In some patients with Cushing's syndrome, the administration of synthetic glucocorticoids appeared to result in an increased urinary steroid excretion. A transient increase in plasma cortisol levels was also observed in some of these patients during the early period of dexamethasone infusion. It is thought that this finding reflects an alteration in steroid metabolism induced by dexamethasone and fluorocortisol.

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.

Cushing's syndrome due to unilateral nodular adrenal hyperplasia: a new pathophysiological entity?

1980 ◽  
Vol 93 (4) ◽  
pp. 495-504 ◽  
Author(s):  
Robert G. Josse ◽  
Robert Bear ◽  
Kalman Kovacs ◽  
H. Patrick Higgins
Keyword(s):  
Adrenal Gland ◽  
Cushing’S Syndrome ◽  
Plasma Cortisol ◽  
Electron Microscopic Examination ◽  
Cushing's Syndrome ◽  
High Dose ◽  
Adrenal Hyperplasia ◽  
Electron Microscopic ◽  
High Dose Dexamethasone ◽  
Steroid Excretion

Abstract. A case is presented of a 43-year-old Caucasian female with Cushing's syndrome, malignant hypertension and renal insufficiency. Plasma cortisol values were elevated (19.5 μg/100 ml at 0800 h and 18.5 μg/100 ml at 2200 h) with loss of diurnal variation and failure of suppression with low and high dose dexamethasone. 17-ketogenic steroid excretion remained unchanged after metyrapone administration. Adrenal vein plasma cortisol values showed prominent left-sided gradient. Gross, histologic and electron-microscopic examination of the left adrenal gland revealed changes of nodular adrenal hyperplasia. The presence of a suppressed right adrenal gland was confirmed post-operatively by a five day ACTH infusion. This case may represent a previously unreported variant of Cushing's syndrome due to unilateral nodular adrenal hyperplasia.

SIMPLIFIED DEXAMETHASONE SUPPRESSION TEST

1969 ◽  
Vol 61 (2) ◽  
pp. 219-231 ◽  
Author(s):  
V. H. Asfeldt
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Clinical Value ◽  
Suppression Test ◽  
The One ◽  
Steroid Excretion ◽  
Dexamethasone Suppression

ABSTRACT This is an investigation of the practical clinical value of the one mg dexamethasone suppression test of Nugent et al. (1963). The results, evaluated from the decrease in fluorimetrically determined plasma corticosteroids in normal subjects, as well as in cases of exogenous obesity, hirsutism and in Cushing's syndrome, confirm the findings reported in previous studies. Plasma corticosteroid reduction after one mg of dexamethasone in cases of stable diabetes was not significantly different from that observed in control subjects, but in one third of the insulin-treated diabetics only a partial response was observed, indicating a slight hypercorticism in these patients. An insufficient decrease in plasma corticosteroids was observed in certain other conditions (anorexia nervosa, pituitary adenoma, patients receiving contraceptive or anticonvulsive treatment) with no hypercorticism. The physiological significance of these findings is discussed. It is concluded that the test, together with a determination of the basal urinary 17-ketogenic steroid excretion, is suitable as the first diagnostic test in patients in whom Cushing's syndrome is suspected. In cases of insufficient suppression of plasma corticosteroids, further studies, including the suppression test of Liddle (1960), must be carried out.

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.

Cyclic Cushing's syndrome combined with cortisol suppressible, dexamethasone non-suppressible ACTH secretion: a new variant of Cushing's syndrome

1985 ◽  
Vol 110 (3) ◽  
pp. 289-295 ◽  
Author(s):  
Hans-Udo Schweikert ◽  
Horst Lorenz Fehm ◽  
Rudolf Fahlbusch ◽  
Rainer Martin ◽  
Rainer Kolloch ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Tissue ◽  
Plasma Cortisol ◽  
Cushing's Syndrome ◽  
Cortisol Secretion ◽  
Plasma Acth ◽  
Acth Secretion ◽  
Normal Response ◽  
New Variant ◽  
Marked Suppression

Abstract. A 55 year old woman with an unusual form of Cushing's disease was studied. During several periods (periods lasting up to 84 days) evidence of cortisol hypersecretion with cycles occurring every 6 days was found. Suppression of plasma cortisol through orally administered dexamethasone (up to 32 mg per day) could not be achieved either during periods of cyclic cortisol hypersecretion or during apparent remission with normal cortisol secretion. Marked suppression of plasma ACTH was measured in response to an iv infusion of 50 mg cortisol over a period of 55 min whereas a similar test with 2 mg dexamethasone (iv bolus) did not suppress ACTH secretion. Transsphenoidal exploration of the sella revealed a tumour surrounding the anterior pituitary. Examination of the pituitary showed a few tiny tumour structures embedded in normal tissue which could not be removed, when the tumour was resected selectively under preservation of normal appearing tissue. Post-operatively, clinical and chemical remission (normal response to 1 mg dexamethasone) was observed for about 4 months. Thereafter, cortisol hypersecretion occurred again necessitating bilateral adrenalectomy. Our results are compatible with the assumption that normal hypothalamic-pituitary-adrenal suppressibility with cortisol, but not with dexamethasone, was caused by the loss of feedback receptors for dexamethasone in the presence of cortisol receptors in the cells which secrete ACTH or CRF. The combination of cyclic hypercortisolism with dexamethasone non-suppressible Cushing's syndrome has not been reported before and thus represents a new variant of Cushing's syndrome.

STUDIES ON THE IN VITRO PRODUCTION OF CORTICOSTEROIDS BY ADRENAL GLANDS FROM NORMOTENSIVE INDIVIDUALS AND HYPERTENSIVE PATIENTS

1962 ◽  
Vol 40 (1) ◽  
pp. 285-301 ◽  
Author(s):  
Jean Davignon ◽  
Erich Koiw ◽  
Wojciech Nowaczynski ◽  
Gilles Tremblay ◽  
Jacques Genest
Keyword(s):  
Cushing’S Syndrome ◽  
Adrenal Glands ◽  
Cushing's Syndrome ◽  
The Other ◽  
Malignant Hypertension ◽  
Unit Weight ◽  
Chromatographic Technique ◽  
Acth Stimulation ◽  
The Mean

The production of aldosterone and other corticosteroids by adrenal glands surgically removed from 5 normotensive subjects with renal disease of various types, 11 patients with arterial hypertension, and 2 with Cushing's syndrome was investigated in vitro by the incubation chromatographic technique. The rate of steroid formation per unit weight of tissue was markedly lower in severe and malignant hypertension and slightly higher in benign hypertension as compared with the rate in normotensive controls. The amount of steroid released varied widely from one gland to the other and showed marked overlapping between the various groups; these variations were most prominent in benign hypertension, less in the normotensive group, and least evident in severe and malignant hypertension. The response of steroidogenesis to ACTH stimulation in vitro was slightly reduced in severe and malignant hypertension. The mean output of aldosterone by adrenal glands from hypertensives was slightly above the mean value obtained with normotensive control glands. The percentage of aldosterone formation in respect to total steroid production was roughly correlated with the severity of hypertension. In four hyperplastic adrenals obtained from two cases of Cushing's syndrome, the in vitro formation of steroids per unit weight of tissue and the response to ACTH did not differ significantly from that found in glands obtained from the other patients under study. The value of in vitro studies for the assessment of the functional capacity of the adrenal cortex is discussed.

EFFECT OF METOPIRONE IN A PATIENT WITH ADRENAL CORTICAL CARCINOMA

1963 ◽  
Vol 44 (3) ◽  
pp. 346-354 ◽  
Author(s):  
H. Daniels ◽  
W. J. van Amstel ◽  
W. Schopman ◽  
C. van Dommelen
Keyword(s):  
Cushing’S Syndrome ◽  
Clinical Effect ◽  
Cushing's Syndrome ◽  
Adrenal Cortical Carcinoma ◽  
List Type ◽  
Adrenal Carcinoma ◽  
Glucocorticoid Production ◽  
Steroid Excretion

ABSTRACT The effect of metopirone® (SU-4885)* in a patient with metastatic adrenal cortical carcinoma was studied. The intention was to depress the symptoms of Cushing's syndrome, due to a high glucocorticoid production by the carcinoma. The excretion of 17-KS, 17-KGS, 11-oxo(y)-17-OHCS and 11-desoxy-17-OHCS was followed for seven weeks. The steroid excretion was variable. The 11-oxo(y)-17-OHCS showed a significant decrease during treatment with SU-4885 for seven weeks. The ratio 11-oxo(y)-17-OHCS: 11-desoxy-17-OHCS fell from 1.7 to 0.1 during this period. The excessive glucocorticoid production of the metastatic adrenal carcinoma was suppressed as long as treatment continued. It was not possible to judge the clinical effect of SU-4885 because of the progressive nature of the disease.

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