The Diagnosis of Hypercortisolism. Biochemical Criteria Differentiating Patients from Lean and Obese Normal Subjects and from Females on Oral Contraceptives

Dh, Streeten; Ct, Stevenson; Tg, Dalakos; Jj, Nicholas; Lg, Dennick; Fellerman, Herbert

doi:10.1210/jcem-29-9-1191

Cited by 122 publications

(26 citation statements)

References 2 publications

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“…Plasma 11-hydroxycorticoids (11-OHCS) were consistently normal, as were urinary 17-hydroxycorticoids (17-OHCS) when corrected for the patient's strikingly evident abundance of muscle mass, by expressing them per gram of creatinine (20 normally to the administration of ACTH, metyrapone, and cortisol. Urinary 17-OHCS excretion showed no rise on a day of KCl-induced paralysis (10.7 mg/day or 3.7 mg/g creatinine per day) or on a day of cold-induced paralysis (13.3 mg/day or 3.8 mg/g creatinine/day).…”

Section: Resultsmentioning

confidence: 99%

Studies on hyperkalemic periodic paralysis. Evidence of changes in plasma Na and Cl and induction of paralysis by adrenal glucocorticoids

Streeten¹,

Dalakos²,

Fellerman³

1971

J. Clin. Invest.

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A B S T R A C T In a 19 yr old male with familial hyperkalemic periodic paralysis, paralysis was consistently induced by the administration of potassium chloride, corticotropin-gel, and a variety of glucocorticoids (dexamethasone, 6-methylprednisolone, triamcinolone) but not by mineralocorticoids (D-aldosterone, deoxycorticosterone) or by adrenocorticotropin (ACTH)-gel plus metyrapone. Induced attacks were virtually identical with spontaneous attacks, being associated, after a latent period of a few hours, with a rise in plasma K+ and HCO3-and a simultaneous fall in plasma Na' and Cl-concentrations to an extent implying exchange of 1 K+ with 2 Na+ and 2 Cl-between extracellular and intracellular fluid. ACTH-induced paralysis was preceded by rising serum inorganic P, and associated with increased plasma glucose, blood lactate, and serum creatine phosphokinase concentrations. In normal subjects ACTH, cortisol, and triamcinolone administration failed to change plasma electrolytes or strength, while ingestion of KCI produced no weakness and smaller changes in plasma K and Na than in the patient.Since the patient and normal subjects showed the same changes in renal excretion of K after the administration of cortisol and KCl, it seems likely that paralysis in the patient resulted from abnormally slow uptake (and/or excessive loss) of K by the muscle cells, possibly caused by an abnormal "ion-exchange pump." Normal adrenocortical function and absence of a peak in plasma 11-hydroxycorticoid (11-OHCS) concentration preceding spontaneous paralysis, indicated that spontaneous paralysis did not result from changes in cortisol secretion. Similar hyperkalemic paralysis was precipitated by ACTH-gel in a brother and first cousin of the Dr. Fellerman is a U. S. Public Health Service Trainee in Endocrinology.

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Section: Resultsmentioning

confidence: 99%

Studies on hyperkalemic periodic paralysis. Evidence of changes in plasma Na and Cl and induction of paralysis by adrenal glucocorticoids

Streeten¹,

Dalakos²,

Fellerman³

1971

J. Clin. Invest.

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“…Urinary 17-OHCS can be adjusted for body mass by dividing by body surface area or urine creatinine. However it was found that some obese subjects may still have adjusted 17-OHCS levels which exceed the range of lean controls (22,81,84,112). Patients with Cushing's syndrome generally have elevated 17-OHCS above the range of lean individuals and obese subjects with simple obesity.…”

Section: Urinary 17 Hydroxycorticosteroidsmentioning

confidence: 99%

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

1995

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“…In six out of eight cases of proven Cushing's syndrome adrenal suppression with 2 mg. per day of dexamethasone was found to be normal. 16 Streeten, Stevenson and Dalakos'6 have emphasized that suppressibility of the pituitary-adrenal axis should be tested with several doses of dexamethasone calculated on the basis of body weight (1-150 ,ug./kg.) which will produce submaximal suppression of urinary 17-OHCS.…”

Section: Discussionmentioning

confidence: 99%

Cushing's Syndrome in Childhood

1972

The Lancet

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The Diagnosis of Hypercortisolism. Biochemical Criteria Differentiating Patients from Lean and Obese Normal Subjects and from Females on Oral Contraceptives

Cited by 122 publications

References 2 publications

Studies on hyperkalemic periodic paralysis. Evidence of changes in plasma Na and Cl and induction of paralysis by adrenal glucocorticoids

Studies on hyperkalemic periodic paralysis. Evidence of changes in plasma Na and Cl and induction of paralysis by adrenal glucocorticoids

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

Cushing's Syndrome in Childhood

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