CLINICAL FEATURES OBSERVED IN PATIENTS WITH AN UNEXPLAINED LOW CORTISOL BINDING CAPACITY

Abstract

ABSTRACT Clinical and biochemical studies have been made on sixty-one untreated patients with a low cortisol binding capacity (C. B. C.), as determined by a gel filtration technique, and no hypoproteinaemia or dysproteinaemia. Characteristic signs and symptoms were found. In the female group, obesity (65 per cent) sometimes suggesting Cushing's disease, diabetes or prediabctes (59 per cent), menstrual disturbances (55 per cent) and hypertension (46 per cent) were the most conspicuous findings. In adult men, diabetes or prediabetes (62 per cent), obesity (29 per cent) and hypertension (29 per cent) were noted. Twelve out of sixteen boys with an unexplained low C. B. C. had disorders of adolescent development, i. e. gynaecomastia (56 per cent), »pseudo-Froehlich« syndrome (44 per cent) and cryptorchidy (20 per cent). In women, the urinary 17-ketosteroids and glucocorticoids were elevated, though the latter values were only slightly above normal; there was a negative and significant correlation between 17,21-dihydroxy-20-ketosteroids and 17-hydroxy-corticoids. In the group of male adults, an increase of urinary glucocorticoids was observed, whereas the excretion of 17-ketosteroids was normal. Both groups showed rather low 8 a. m. unconjugated plasma corticoid levels. The low cortisol binding capacity in these patients was found to be independent of adrenocortical function, excess of weight, or technical artefacts. The response to oestrogens (endogenous or exogenous) was clearly defective. Whether the low plasma cortisol binding capacity itself is the cause of the clinical and biochemical findings observed in these patients, remains to be elucidated.