URINARY CORTICOSTEROID EXCRETION PATTERNS IN PATIENTS WITH ADRENOCORTICAL DYSFUNCTION*

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Abstract
A technique is described for obtaining patterns of the urinary excretion of steroids containing Δ4-3-keto- and α-ketolic groupings. The patterns in normal subjects showed the presence of pregnane-3α, 11β,17α,21-tetrol-20-one (THF), pregnane-3α,17α,21-triol-11,20-dione (THE), cortisol (compound F), cortisone (compound E), and 5 unidentified compounds X1, X6, X9, X10 and X11. In addition, corticosterone (compound B) was excreted in 1 patient, and pregnane-3α-11β,21-triol-20-one (THB) in 2 normal subjects. Compounds THE and THF were the chief metabolites. In 3 patients with Cushing's syndrome similar compounds were present on the paper chromatograms. However, they were excreted in much larger amounts. During administration of ACTH, all of the α-ketolic steroids were further increased, the greatest rise occurring in the active hormones F and E. There was no increase in the amounts of the fast-moving compounds X9 to X11. After adrenalectomy these substances disappeared from the patterns, and compounds X1, THF, THE, F, E and X6 were observed as metabolites of the administered cortisone. A patient with panhypopituitarism presented qualitatively a normal distribution of corticosteroids. Quantitatively, however, the amounts of all the individual compounds were decreased and remained unchanged after administration of ACTH. A patient with Addison's disease showed no α-ketolic steroids, except for traces of THF and THE, in both the untreated state and during administration of ACTH. A boy with congenital adrenal hypcrplasia had an abnormal excretion pattern. He excreted large amounts of pregnane-3α,17α,21-triol-20-one (THS) and smaller amounts of 11-desoxycortisol (compound S), both of which became almost completely suppressed by cortisone therapy. A 21-year-old girl with the adrenogenital syndrome had a normal pattern of corticosteroid excretion. After the administration of ACTH, relatively large amounts of compound THS could be demonstrated in the urine. Therapy with 9α-fluorohydrocortisone only slightly suppressed the excretion of all the individual corticosteroids.