VERSAGEN DES INTRAVENÖSEN ACTH-TESTS BEI EINEM FALL VON CUSHING-SYNDROM INFOLGE BILATERALER HYPERPLASIE DER NEBENNIERENRINDE

Abstract

ABSTRACT A case report is given of a patient with Cushing's syndrome due to bilateral adrenocortical hyperplasia. The 17-OHCS in plasma showed only a low or none response to corticotrophin (ACTH), administered intravenously. The elevated excretion of 17-OHCS in urine exhibited a further increase following the first ACTH administration, but were not depressed significantly after 120 mg triamcinolone within four days. No reaction of urinary 17-OHCS was seen following a second ACTH-infusion. A plausible explanation for these phenomena can not be given. After bilateral adrenalectomy measurable amounts of 17-OHCS were excreted in urine, probably reflecting the steroid secretion of aberrant adrenal cortical tissue. Plasma clearance of exogenous cortisol was some-what delayed without disturbed formation of conjugated steroids. Postoperative well-being of the patient was achieved only by treatment with the 21-deoxysteroid oxylone or with triamcinolone combined with deoxycorticosterone acetate.