ALDOSTERON, CORTISOL UND CORTISON IM HARN UND IN OPERATIV ENTFERNTEN NEBENNIEREN BEI PATIENTEN MIT CUSHING-SYNDROM

Abstract

ABSTRACT Few studies on the excretion of cortisol and cortisone in urine with simultaneous estimations of aldosterone have been performed in cases of Cushing's Syndrome. Using the methods of Neher & Wettstein (1956) for the determination of cortisol, cortisone and aldosterone, studies were made on 8 patients with Cushing's Syndrome and adrenocortical hyperplasia. The excretion of aldosterone was normal in 5 cases and increased in 3 cases. The increase in excretion of cortisol was much greater than that of cortisone, while the excretion of 17-OHCS though frequently increased, was not very large. In 5 cases cortisol, cortisone, aldosterone and the 17-OHCS were determined in urine after the administration of ACTH. In these experiments the excretion of cortisol and cortisone was much higher than that of 17-OHCS. In one case, the amount of cortisol was found to be almost 200 times the upper normal limit. The excretion of aldosterone was slightly elevated in one case but showed considerable increases in 2 cases. 2 patients were given SU 4885 for several days. After this treatment the excretion of aldosterone was considerably decreased (<0.5 μg), cortisol and cortisone could, however, still be measured in small quantities. One of the 2 patients showed a new increase of cortisol excretion amounting to 10 times the upper limit during the fourth day of administration of SU 4885. A considerable elevation of 17-OHCS in the urine was also found. One of the patients was given dexamethasone, which brought about a decrease in cortisol, cortisone and 17-OHCS in the urine, the aldosterone content remaining at a normal level. In addition cortisol, cortisone, corticosterone and aldosterone were determined by the method of Neher (1958), in the adrenals of 6 patients following operation. Taking the few corresponding studies on normal adrenals as a standard our results expressed in percentage showed an increased cortisol content. According to our experiments the estimation of cortisol in urine is a more valuable diagnostic tool in Cushing's Syndrome than that of 17-OHCS. Furthermore the excretion of both cortisol and aldosterone is not constant. The production of both hormones can be stimulated by ACTH.