ADRENOCORTICAL HETEROFUNCTION

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Abstract
The urine of 26 patients with virilism due to adrenocortical hyperplasia was analyzed for the presence of pregnane-3a, 17a, 20a-triol-ll-one. Detectable amounts of the steroid were found only in patients with adrenal dysfunction classified either as female pseudohermaphrodites or macrogenitosomia praecox and Cushing''s syndrome. It may also be present in exceptional cases of intermediary virilism, not fully developed female paeudohermaphrodit-ism. In adult patients of the female pseudohermaphrodite or macro-genitosomia praecox group, pregnanetriolone was excreted in milli-gram quantities (3-9 mg/24 hr.); 1/20 of the 24 hr. urine collection was found to be sufficient for analysis. The detection of the substance in newborn pseudohermaphrodites requires the entire 24-hr, urine collection for analysis, as the excretion is lower (0.08-1 mg/24 hr.). The excretion of pregnanetriolone was also low in patients of the Cushing''s syndrome group (0.05-0.4 mg/24 hr), and therefore the entire 24-hr. pool should be used. The substance was not found in the urine of normal subjects, pregnant women, patients with hirsutism or in the majority of cases (10 out of 11) of idiopathic virilism. Preg-nanetriolone was not found in significant concentrations in 5 cases of adrenal adenoma (3 benign and 2 malignant). The finding of less than 2ug/24 hr. of pregnanetriolone in the urine of normal subjects justifies the assumption that normally the substance is not excreted in the urine. The difference, therefore, between normal subjects and patients with adrenal hyperplasia is qualitative. To describe this functional difference the term adrenocortical heterofunction has been suggested.