A CASE OF ADRENOCORTICAL HYPERFUNCTION NORMALIZED DURING THE SECOND AND THIRD TRIMESTERS OF THREE PREGNANCIES

Abstract

ABSTRACT Detailed hormonal studies were performed before, during and after three pregnancies in an untreated patient with adrenocortical hyperfunction due to hyperplasia. The patient was clinically characterized by oligomenorrhoea and moderate hirsutism, but showed no signs of virilization or of Cushing's disease. In the non-pregnant state her 17-ketosteroid excretion was elevated to twice the normal value, the androsterone fraction being moderately and the aetiocholanolone fraction greatly elevated, whereas the excretion of dehydroepiandrosterone was essentially normal. In the non-pregnant state the excretion of 17-ketogenic steroids, tetrahydrocortisol, tetrahydrocortisone, cortisone and tetrahydrocorticosterone was also considerably elevated. On high doses of dexamethasone (8 mg daily) or cortisone (100 mg daily) all fractions of 17-ketosteroids as well as the cortisol metabolites were suppressed to about one-half. Without preceding or simultaneous steroid treatment the patient conceived three times. During all three pregnancies every sign of excessive hormone production ceased. The excretion of 17-ketosteroids in all fractions fell to 20–30%, that of 17-ketogenic steroids to between 30% and 35 %, and that of cortisol metabolites to between 5 % and 46 % of the levels found before and after the pregnancies. The considerable endocrine activity of the foeto-placental unit may have "normalized" the maternal hypothalamic-pituitary-adrenocortical feed-back mechanism, either by suppressing or by altering the sensitivity of the feed-back system. An alternative theory might be an accelerated rate of cortisol metabolism by the liver in the non-pregnant state which is normalized during the last two trimesters of the pregnancies. The findings are being published as a contribution to the elucidation of the endocrinology of pregnancy.