ASSESSMENT OF THE FUNCTIONAL CAPACITY OF THE ADRENAL CORTEX. II. CLINICAL APPLICATION OF THE ACTH TEST*

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Abstract
In order to verify its clinical usefulness, the ACTH test was performed in a series of 32 proved cases of adrenocortical hyper-function and hypofunction. The results were above the previously established upper fiducial limit of normal response in the cases of hyperfunction, and below the lower limit in the cases of hypofunction. The present study confirms the findings of earlier investigators, that adrenocortical adenoma and adrenocortical hyperplasia with Cushing''s syndrome exhibit different reaction patterns to stimulation with ACTH. In addition, the existence of patients with a normal resting excretion of corticosteroids but complete lack of adrenocortical reserve capacity was confirmed. Sixty-six patients with at least one of the following six classic symptoms of Addison''s disease (loss of weight, weakness, hyperpigmentation, hypotonia, hypo-glycemia, and disturbance in electrolyte and/or water metabolism) were studied clinically and with the aid of the ACTH test. The clinical investigation excluded other debilitating disease as a possible cause of the symptoms (s). In 43 of the 66 patients there was a pathologically low urinary corticosteroid response to stimulation with ACTH. In approximately half of these cases there was also a pathologically low pretreat-ment resting excretion of corticosteroids. Almost without exception, the patients showing a normal response to ACTH had only one clinical symptom, namely, weakness. About 80 per cent of the patients with two or more symptoms showed a pathologically low excretion of corticosteroids in response to ACTH. The results indicate that the previously described method for the assessment of adrenocortical reserve capacity makes clinical sense.