Cushing's Syndrome. IV. Urinary 17-Ketosteroids in Patients with Adrenal Cortical Tumors.

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Abstract
In 5 patients with Cushing's syndrome due to adrenal cortical tumors, urinary 17-ketosteroids were fractionated by column chromatography and identified by infrared spectroscopy. The findings were: 1. One patient with benign adrenal cortical adenoma had a low value of total urinary 17-ketosteroids. The only steroids identified were 11-oxygenated 17-ketosteroids. 2. Four patients with adrenal cortical carcinoma showed elevated urine 17-ketosteroid levels. All 4 had absolute increases in the quantity of 11-oxy-17-ketosteroids. All showed increases in ratio of etiocholanolone to androsterone. Only one showed a marked increase in amount of dehydroisoandrosterone. 3. Certain similarities to and differences from the 17-ketosteroid pattern of patients with Cushing's syndrome due to bilateral adrenal hyperplasia are pointed out. It is suggested that the urinary 17-ketosteroid excretion pattern in patients with Cushing's syndrome due to adrenal carcinoma may not always be sufficiently characteristic to point to a diagnosis of tumor as opposed to hyperplasia of the adrenal cortex.