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.

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.

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]

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.

QUANTITATIVE ESTIMATION OF URINARY PREGNANETRIOL, PREGNANETRIOLONE, TETRAHYDRO S AND Δ5-PREGNENETRIOL IN THE INVESTIGATION OF ADRENOCORTICAL FUNCTION

1969 ◽  
Vol 60 (4) ◽  
pp. 657-668 ◽  
Author(s):  
Frances J. Thomas ◽  
A. W. Steinbeck
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Cushing’S Syndrome ◽  
Adrenocortical Carcinoma ◽  
Quantitative Estimation ◽  
Cushing's Syndrome ◽  
Adrenocortical Function ◽  
Adrenal Hyperplasia ◽  
Ectopic Acth ◽  
Modified Method ◽  
Idiopathic Hirsutism

ABSTRACT A modified method for the estimation of urinary pregnanetriol, pregnanetriol, pregnanetriolone, Δ5-pregnenetriol and tetrahydro S was investigated. The steroids, separated by chromatography, were measured quantitatively, tetrahydro S by reaction with blue tetrazolium and the other three as acetaldehydogenic substances. The excretion of these steroids was studied in suspected instances of adrenal and/or ovarian disease. Urinary pregnanetriol and tetrahydro S levels were normal in Cushing's syndrome, secondary adrenocortical carcinoma, the Stein-Leventhal syndrome, idiopathic hirsutism and hypertension. Tetrahydro S was doubtfully elevated in an instance of ectopic ACTH Cushing's syndrome. Pregnanetriol excretion was elevated in untreated cases of congenital adrenal hyperplasia and after treatment in some. Pregnanetriolone was found in all patients with congenital adrenal hyperplasia, including those receiving cortisone. Pregnanetriolone was also detected in Cushing's syndrome, secondary adrenocortical carcinoma, the Stein-Leventhal syndrome, ectopic ACTH Cushing's syndrome and suspected congenital adrenal hyperplasia. Δ5-pregnenetriol was present as a glucuronide in the Stein-Leventhal syndrome and idiopathic hirsutism. The diagnostic implications of these results are discussed.

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.

Serum cortisol concentrations during low dose dexamethasone suppression test to screen for Cushing's syndrome

BMJ ◽  
1985 ◽  
Vol 290 (6462) ◽  
pp. 158-159
Author(s):  
L. Kennedy ◽  
D. Hadden ◽  
B. Atkinson ◽  
B Sheridan ◽  
H. Johnston
Keyword(s):  
Cushing’S Syndrome ◽  
Low Dose ◽  
Serum Cortisol ◽  
Cushing's Syndrome ◽  
Dexamethasone Suppression Test ◽  
Suppression Test ◽  
Dexamethasone Suppression

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.

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