URINARY ESTROGEN EXCRETION IN CUSHING'S SYNDROME*

Abstract
Since overproduction of estrogens could conceivably play a role in the pathologic physiology of Cushing''s syndrome, an attempt was made to isolate, identify, and quantitate the urinary estrogens excreted by a 58-year-old postmenopausal woman with metastatic adrenocortical carcinoma and Cushing''s syndrome. By means of countercurrent distribution and paper chromatography, estrone and estriol were identified and isolated in a fluorometrically homogeneous form. During the control period the patient excreted 5.7 micrograms of estrone and 34.2 micrograms of estriol daily as measured by photo-fluorometry. Upon the administration of ACTH, the excretion of estrone increased 12-fold and that of estriol 5-fold. The isolated estrogens were assayed for biologic activity and the positive results were in reasonable agreement quantitatively with the fluorometric measurements. The acetate derivatives of the isolated estrogens were prepared, and their behavior upon paper chromatography was found to be identical with that of appropriate reference standards of authentic estrogen acetates. No estradiol-17[beta] was found in the control urine, but traces were detectable by paper chromatography during the ACTH period. The relatively high urinary excretion of estrone and estriol by this postmenopausal woman with adrenocortical carcinoma and the increased estrogen excretion with ACTH stimulation suggest that these estrogens or their precursors were produced by the adrenocortical carcinoma and that this function of the tumor tissue was not autonomous.