VERSAGEN DES INTRAVENÖSEN ACTH-TESTS BEI EINEM FALL VON CUSHING-SYNDROM INFOLGE BILATERALER HYPERPLASIE DER NEBENNIERENRINDE

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Abstract
A case report is given of apatient with Cushing''s syndrome due to bilateral adrenocortical hyperplasia. The 17-OHCS in plasma showed only a low or none response to corticotrophin (ATH), administered intravenously. The elevated excretion of 17-OHCS in urine exhibited a further increase following the first ACTH administration, but were not depressed significantly after 120 mg triamcinolone within four days. No reaction of urinary 17-OHCS was seen following a second ACTH-infusion. A plausible explanation for these phenomena can not be given. After bilateral adrenalectomy measurable amounts of 17-OHCS were excreted in urine, probably reflecting the steroid secretion of aberrant adrenal cortical tissue. Plasma clearance of exogenous cortisol was somewhat delayed without disturbed formation of conjugated steroids. Postoperative well-being of the patient was achieved only by treatment with the 21-deoxysteroid oxylone or with triamcinolone combined with deoxycorticosterone acetate.