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.

CORTICOSTEROIDS IN HUMAN BLOOD

1969 ◽  
Vol 60 (1) ◽  
pp. 13-35 ◽  
Author(s):  
Ludwig Kornel
Keyword(s):  
Essential Hypertension ◽  
Cushing’S Syndrome ◽  
Plasma Levels ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Normal Range ◽  
Upper Limit ◽  
Before And After ◽  
Intensive Work ◽  
Kinetics Of

ABSTRACT As an extension of our study on corticosteroid metabolism in essential hypertension, plasma levels of »free«, »polar free«, glucuronide and sulfate conjugated 17-hydroxycorticosteroids (17-OHCS), as well as »total conjugated« 17-OHCS, have been determined in 13 patients with Cushing's syndrome and 56 healthy people, before and after administration of corticotrophin (ACTH). Levels of these steroid fractions were also compared in normal subjects during rest and after intensive work. Furthermore, kinetics of the formation and disposal of each of these steroid fractions were investigated in vivo in 3 normal subjects and 3 patients with Cushing's syndrome, by means of radioisotopic tracer techniques. The results obtained indicated the following: (1) although mean levels of each of the estimated 17-OHCS fractions, both before and after ACTH, were in Cushing's syndrome statistically significantly higher than in normal subjects (exception: 17-OHCS-sulfates after ACTH), many individual values for steroid concentrations in Cushing patients were well below the upper limit of the normal range; (2) levels of conjugated and »polar free« 17-OHCS in these patients were much more often increased above the normal range than those of »free« steroids usually measured; moreover, levels of these steroids in the control specimens constituted a much better index of adrenocortical hyperactivity than those after ACTH administration; (3) arithmetical formulae were construed, taking into account both an absolute increase in steroid levels and a relative increase in levels of conjugated and »polar free« steroids above those of »free« 17-OHCS, which permitted a clear-cut separation of all patients with Cushing's syndrome from normal subjects; (4) in the sulfate conjugated 17-OHCS fraction in Cushing patients, the increase in levels of more polar steroids (extractable with ethyl acetate following solvolysis and removal of less polar steroids with dichloromethane) was statistically significantly greater than that of less polar steroids (extractable with dichloromethane), thus, patients with Cushing's syndrome resembled from this angle patients with essential hypertension; (5) when steroid levels in normal subjects were compared during rest and during intensive work, a proportional increase in all steroid fractions during work was noted; this points to a perfect homeostatic mechanism involving enzyme systems metabolizing cortisol under »normal« stressful conditions; (6) however, after ACTH administration, the increase in the levels of conjugated steroids in normal subjects considerably exceeded that of »free« 17-OHCS; in contrast, in Cushing patients the increase in the conjugated 17-OHCS after ACTH administration was relatively smaller than that of »free« 17-OHCS; this, it is believed, indicates that the level of activity of enzymes metabolizing cortisol is in patients with Cushing's syndrome closer to the upper limit of these enzymes' capacity than in normal subjects, possibly due to a chronic saturation with higher steroid concentrations; (7) the results of the radioisotopic tracer study of the kinetics of formation and disposal of various free and conjugated plasma corticosteroid fractions demonstrated that, under basal conditions: (a) biological halflife of cortisol in Cushing patients is shorter than in normal subjects, (b) rates of formation of conjugated and polar free metabolites are much faster in Cushing patients than in normal subjects; this indicates that patients with Cushing's syndrome develop adaptive mechanisms to metabolize chronically increased loads of cortisol, and explains why plasma levels of »polar free« and conjugated 17-OHCS are a better index of adrenocortical hyperactivity than those of the »free« steroids, usually measured.

Measurement of urinary free 20 alpha-dihydrocortisol in biochemical diagnosis of chronic hypercorticoidism.

1986 ◽  
Vol 32 (5) ◽  
pp. 808-810 ◽  
Author(s):  
M Schöneshöfer ◽  
B Weber ◽  
W Oelkers ◽  
K Nahoul ◽  
F Mantero
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Values ◽  
Excretion Rate ◽  
Normal Subjects ◽  
Urinary Free Cortisol ◽  
Cushing's Syndrome ◽  
Normal Range ◽  
Free Cortisol ◽  
Adrenal Secretion ◽  
Stimulation Of

Abstract Using liquid chromatography, we estimated the urinary excretion of 20 alpha-dihydrocortisol (20-DH) and urinary free cortisol (UFC) in normal subjects and in 40 patients with Cushing's syndrome of different etiologies. The median normal excretion rate (nmol/24 h) was 174 for 20-DH and 68 for UFC, the 20-DH/UFC ratio thus being 2.55. For patients with Cushing's syndrome, the excretion rate was 1798 for 20-DH and 298 for UFC, the ratio 6.03. We evaluated the effect of acute stimulation of adrenal secretion on 20-DH and UFC by administering corticotropin to six normal subjects. After such stimulation, the excretion rate was 566 for 20-DH and 1238 for UFC (ratio 0.45). Whereas 20-DH excretion rate exceeded the normal range in all patients, six patients had normal or even below-normal values for UFC excretion. Evidently, measurement of urinary 20-DH is a better test for chronic hypercorticoidism than is measurement of urinary UFC, and chronic hypercorticoidism can be differentiated from the acute state by the 20-DH/UFC ratio.

scholarly journals Urinary Free 11-Hydroxycorticosteroid/Creatinine Ratios in Early Morning Urine Samples as an Index of Adrenal Function

1977 ◽  
Vol 14 (1-6) ◽  
pp. 203-206 ◽  
Author(s):  
Michael S. Walker
Keyword(s):  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Early Morning ◽  
Cushing's Syndrome ◽  
Urine Samples ◽  
Creatinine Ratio ◽  
Laboratory Staff ◽  
The Mean ◽  
Age Range ◽  
Normal Laboratory

Urinary free 11-hydroxycorticosteroid/creatinine ratios were determined in early morning urine samples from 113 females (age range 20–45 years) and 65 males (age range 22–45 years). Basal values in normal subjects fluctuated between 5 and 55 μmol/mol creatinine. In four patients in whom Cushing's syndrome was diagnosed, urinary free 11-hydroxycorticosteroid/creatinine ratios were greater than 85 μmol/mol creatinine. Administration of dexamethasone (0.5 mg/q.i.d.) to nine normal laboratory staff for two days resulted in a suppression of the urinary free 11-hydroxycorticosteroid/creatinine ratio to less than 50% of the mean basal value in all cases. This degree of suppression did not occur in two cases of Cushing's syndrome due to adrenal tumours.

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.

GASCHROMATOGRAPHIC DETERMINATION OF STEROIDS IN THE URINE OF PATIENTS WITH CUSHING'S SYNDROME

1971 ◽  
Vol 67 (2) ◽  
pp. 303-315 ◽  
Author(s):  
A. J. Moolenaar ◽  
A. P. van Seters
Keyword(s):  
Liquid Chromatography ◽  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Diagnostic Value ◽  
Cushing's Syndrome ◽  
Gas Liquid Chromatography ◽  
Obese Subjects

ABSTRACT The 17-oxosteroids were estimated in the urine of 27 patients with Cushing's syndrome by gas-liquid chromatography (G. L. C.). The values of the various steroid fractions are compared with those of normal subjects, patients with thyrotoxicosis and obese subjects. The effect of the age of the patients on the diagnostic value of the invidual 17-oxosteroids and their ratios is 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.

The Influence of Acenocumarole on the Fibrinogen-turnover in Normal Subjects, Venous Thrombosis and Congestive Heart Failure

1972 ◽  
Vol 28 (03) ◽  
pp. 496-508
Author(s):  
A. P. C. van der Maas ◽  
F. A. G Teulings ◽  
W Schopman ◽  
G. J. H. den Ottolander
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Venous Thrombosis ◽  
Anticoagulant Therapy ◽  
Normal Subjects ◽  
Time Interval ◽  
Normal Range ◽  
The Mean ◽  
The Moment ◽  
Continuous Deposition

SummaryUsing 131Iodine-tagged fibrinogen the influence of acenocumarole on the biological half-life of fibrinogen was investigated in healthy patients, patients with venous thrombosis and patients with congestive heart failure.In 16 healthy patients the mean t½ was 3.8 days. In two of them after administration of acenocumarole the t½ was lengthened. This supports the opinion of a continuous deposition of fibrin on the vascular endothelium in the hemostatic balance.In 13 patients with venous thrombosis the mean t½ was 2.45 days, lengthening to the normal range after acenocumarole therapy. The time interval between the start of acenocumarole therapy and the moment of normalization of the t½ was approximately 4 days. The prothrombin time-index at this moment was 2.3 (thrombotest 5%), which argues in favour of a vigorous anticoagulant therapy.In our 10 patients with congestive heart failure probably venous thrombosis occurred in 40%. Prophylactic anticoagulant therapy as in surgical patients therefore has to be considered.

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.

FEHLENDER ANSTIEG DER CORTICOSTEROIDE IM PLASMA WÄHREND DER INSULINHYPOGLYKÄMIE BEIM CUSHING-SYNDROM

1966 ◽  
Vol 51 (2) ◽  
pp. 166-174 ◽  
Author(s):  
H. Bethge ◽  
W. Winkelmann ◽  
H. Zimmermann
Keyword(s):  
Plasma Level ◽  
Cushing’S Syndrome ◽  
Normal Subjects ◽  
Cushing's Syndrome ◽  
Adrenal Hyperplasia ◽  
Acth Secretion ◽  
Initial Value ◽  
Stressful Stimulus ◽  
Acth Release

ABSTRACT Four patients with Cushing's syndrome associated with adrenal hyperplasia were submitted to insulin-induced liypoglycaemia. It was shown that contrary to conditions in normal subjects the Cushing-patients failed to respond to hypoglycaemia with an increase of corticosteroids in plasma. This effect was independent of the initial value of corticoid level. It is concluded that pituitary ACTH-release during hypoglycaemia in patients with Cushing's syndrome did not markedly increase. The findings are discussed under the aspects of primary hypothalamic pathogenesis of Cushing's syndrome: ACTH-secretion and plasma level are constant throughout the day and widely independent from exogenous and endogenous influences including such a stressful stimulus as hypoglycaemia.

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.

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