Effect of 9 -Fluorohydrocortisone on Adrenal Hyperfunction in Cushing's Syndrome

Cope, C. L.; Harrison, R. J.

doi:10.1136/bmj.2.4937.457

Cited by 16 publications

(3 citation statements)

References 7 publications

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“…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. Jenkins and Spence (22), employing 9a-fluorocortisol in dosages of 1 mg. or 2.5 mg. every six hours for two or three days, demonstrated partial suppression of urinary 17-hydroxycorticoid excretion in 2 of 3 patients with Cushing's syndrome and adrenal hyperplasia.…”

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

confidence: 94%

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: 94%

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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“…A study in children with autism showed alterations in the normal circadian patterns of cortisol (25). The value of urinary free cortisol in assessing of adrenocortical function was first pointed out by Cope (26,27), who found that it detected increased adrenocortical function. Other studies also confirmed that an increase in the plasma concentration of free cortisol was accompanied by a linear increase in cortisol excretion in the urine (28).…”

Section: Discussionmentioning

confidence: 99%

Abnormal circadian rhythm and cortisol excretion in autistic children: a clinical study

et al. 2013

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AimTo determine the circadian rhythm alteration of cortisol excretion and the level of corticosteroids in children with different grades of autism severity.MethodsThe study included 45 children with different grades of autism severity (low [LFA], medium [MFA], and high functioning autism [HFA]), 15 in each group, and 45 age/sex-matched children with typical development. The urinary levels of free cortisol (at three phases of 24-hour cycle), corticosteroids, vanilylmandelic acid, and 5-hydroxyindole acetic acid were determined.ResultsAlteration in the pattern of cortisol excretion (Phases I, II, and III) was observed in children with LFA (Phase I: 43.8 ± 4.43 vs 74.30±8.62, P = 0.000; Phase II: 21.1±2.87 vs 62±7.68, P < 0.001; Phase III: 9.9 ± 1.20 vs 40 ± 5.73, P < 0.001) and MFA (Phase I: 43.8 ± 4.43 vs 52.6±7.90, P < 0.001; Phase II: 21.1±2.87 vs 27.4±4.05, P < 0.001; Phase III: 9.9 ± 1.20 vs 19 ± 2.50, P < 0.001) compared to the control group. The corticosteroids excretion levels were higher in all the groups of children with autism than in the control group. The level of 5-hydroxyindole acetic acid was significantly higher in children with LFA (8.2±1.48 vs 6.8±0.85, P < 0.001) and MFA (8.2±1.48 vs 7.4± 0.89, P = 0.001) and not significantly higher in children with HFA than in the control group. The changes were correlated with degrees of severity of the disorder.ConclusionThese data suggest that altered cortisol excretion pattern and high level of corticosteroids in urine may probably be a consequence of altered hypothalamic-pituitary-adrenal axis function, which may contribute to the pathogenesis and affect the severity of autism.

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“…There are several reasons why the reaction in plasma is better than tests in urine. It was shown by us as long ago as 1955 (Cope & Harrison 1955) that in an occasional case of Cushing's syndrome the inhibition might be too slight to be revealed by the relatively slowly changing urinary metabolites, yet might show in the urine cortisol. This implies that a transient fall in plasma level has occurred in such cases.…”

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confidence: 99%

Some Adrenal Facts and Fancies

1965

Proceedings of the Royal Society of Medicine

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Effect of 9 -Fluorohydrocortisone on Adrenal Hyperfunction in Cushing's Syndrome

Cited by 16 publications

References 7 publications

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

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

Abnormal circadian rhythm and cortisol excretion in autistic children: a clinical study

Some Adrenal Facts and Fancies

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