ADRENOCORTICAL INSUFFICIENCY WITH NORMAL BASAL LEVELS OF URINARY 17-HYDROXYCORTICOIDS: DIAGNOSTIC IMPLICATIONS*†

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Abstract
Adrenocortical function has been studied in 7 patients who had some of the symptoms of Addison''s disease, yet had normal basal levels of 17-hydroxycorticoid excretion in the urine. Tetrahydrocortisone was the major component of the urinary 17-hydroxycorticoids. Its identity was established by paper chromatographic separation and sulfuric-acid spectrum. None of the patients responded to the intravenous administration of ACTH by a rise in steroid excretion, thus demonstrating the absence of any significant adrenocortical reserve. In 6 of the 7 patients hyperpigmentation was the first symptom observed, and in 2 it was the patient''s only complaint. The clinical recognition of partially compensated adrenocortical insufficiency is of practical importance, since under conditions of severe stress acute adrenal insufficiency may occur and may go unrecognized.