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

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Abstract
Clinical and biochemical studies have been made on 61 untreated patients with a low cortisol binding capacity (C.B.C.), as determined by a gel filtration technique, and no hypoproteinemia or dysproteinemia. Characteristic signs and symptoms were found. In the female group, obesity (65%) sometimes suggesting Cushing''s disease, diabetes or prediabetes (59%), menstrual disturbances (55%) and hypertension (56%) were the most conspicuous findings. In adult men, diabetes or prediabetes (62%), obesity (29%) and hypertension (29%) were noted. Twelve out of 16 boys with an unexplained low C. B. C. had disorders of adolescent development, i.e. gynecomastia (56%), pseudo-Froehlich syndrome (44%) andcryptorchidy (20%); 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-keto-steroids 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 estrogens (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.