Advances in the Diagnosis of Altered States of Adrenocortical Function

Laidlaw, J. C.; Reddy, William J.; Jenkins, Dalton; Haydar, Najib Abu; Renold, Albert E.; Thorn, George W.

doi:10.1056/nejm195511032531801

Cited by 79 publications

(13 citation statements)

References 17 publications

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“…Laidlaw et al (19), administering 5 mg. of 9a-nuorocortisol twice daily for four days to 3 patients and 25 mg. daily for three days to 1 patient with Cushing's syndrome and adrenal hyperplasia, failed to demonstrate a significant decrease in either 17-ketosteroid or 17-hydroxycorticoid excretion. However, Cope and Harrison (20,21) in a study of 3 cases of Cushing's syndrome associated with adrenal hyperplasia and 1 associated with adrenocortical carcinoma noted that, in response to 9a-fluorocortisol in divided doses totalling 5 to 10 mg. per day, all 3 patients with adrenal hyperplasia exhibited partial suppression of urinary corticosteroid excretion whereas the patient with carcinoma did not.…”

Section: Results Of Present Study As Related To Those Previously Repomentioning

confidence: 99%

Tests of Pituitary-Adrenal Suppressibility in the Diagnosis of Cushing's Syndrome*

Liddle

1960

The Journal of Clinical Endocrinology & Metabolism

711

213

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Past attempts to test suppressibility of pituitary-adrenal function by the use of exogenous corticoids have yielded inconsistent findings in patients with Cushing's syndrome. The present study indicates that, with proper selection of suppress]ve agent and adjustment of dosage, valuable diagnostic information can be obtained from such tests. A a -9a!-Fluorocortisol (AFF) and its 16o:-methylated analog (dexamethasone) were employed as suppressive agents. At dosage levels of 0.5 mg. every six hours for 8 doses these agents induced almost complete suppression of 17-hydroxycorticoid excretion in all 54 endocrinologically normal subjects tested. In contrast, all 35 of the patients with true Cushing's syndrome who were studied maintained relatively high urinary 17-hydroxycorticoid levels during such treatment. At these low dosages, therefore, the suppressive agents were useful in separating patients with Cushing's syndrome from those with normal adrenal function. Administration of AFF or dexamethasone in larger dosages of 2.0 mg. every six hours for 8 doses was used to separate patients with ACTH-dependent hyperadrenocorticism from those with autonomously functioning adrenal tissue. In response to large doses of suppressive agents, all patients with bilateral adrenocortical hypersecretion exhibited a definite decrease in 17-hydroxycorticoid excretion, whereas patients with adrenocortical tumors did not. The results support the view that the primary disorder in Cushing's syndrome with bilateral adrenocortical hypersecretion involves alteration of pituitary function in such a way that ACTH secretion is not suppressed by normal levels of cortisol.

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Section: Results Of Present Study As Related To Those Previously Repomentioning

confidence: 99%

Tests of Pituitary-Adrenal Suppressibility in the Diagnosis of Cushing's Syndrome*

Liddle

1960

The Journal of Clinical Endocrinology & Metabolism

711

213

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“…Patients with adrenal insufficiency excrete large quantities of water by night (Robin¬ son, Power & Kepler, 1941 ;Levy, Power & Kepler, 1946) so that the day-night ratio of urine output is reduced and may approximate to unity (Prunty, McSwiney, Mills & Smith, 1950;Finkenstaedt, Dingman, Jenkins, Laidlaw & Merrill, 1954). The rhythm has been restored to normal in patients with Addison's disease by the administration of cortisone in the mornings (Prunty et al 1950), while it may be absent in patients with Cushing's syndrome (Laidlaw, Reddy, Jenkins, Abu Haydar, Renold & Thorn, 1955;Mellinger & Smith, 1956). The ketosteroid excretory rhythm approximately parallels that of urine excretion (Pincus, 1943;Pincus & Hoagland, 1943) and it has been suggested that this may indicate the controlling role of the adrenal cortex.…”

Section: Discussionmentioning

confidence: 95%

A Study of the Roles of Adrenocortical Steroids and Glomerular Filtration Rate in the Mechanism of the Diurnal Rhythm of Water and Electrolyte Excretion

Martel¹,

Sharp²,

Slorach³

et al. 1962

Journal of Endocrinology

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1. An investigation of the mechanism of diurnal excretory rhythms has been carried out on four healthy male subjects in whom the excretory rhythms were reversed by a 12 hr. shift of the activity-sleep and lightdark schedules.2. The diurnal rhythms of water, sodium, potassium, creatinine and ketogenic steroid excretion adapted to the reversal of routine at different rates.3. It is concluded, from the dissociation of these rhythms during the reversal phase, that the ketogenic steroids are not controlling either the major variation of glomerular filtration rate or the excretory rhythms of water and sodium. 4. The potassium excretory rhythm appears to be linked with the ketogenic steroid rhythm.5. The mechanism of the diurnal rhythm of urine flow is discussed in relation to these findings.

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“…[2]. D u rin g th e first a n d second d a y o f A CTH stim u la tio n th e b re a st can cer group show ed a low er u rin a ry excretion o f 1 7 -ketosteroids an d 1 7 -h y d ro x y co rtico stero id s th a n th e co n tro l group.…”

Section: Discussionmentioning

confidence: 99%