THE EXCRETION OF INDIVIDUAL 17-OXOSTEROIDS IN CUSHING'S SYNDROME

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Abstract
SUMMARY: The urinary excretion levels of individual 17-oxosteroids in eight patients with Cushing's syndrome have been determined quantitatively. Using these values approximate secretion rates of cortisol and 11β-hydroxyandrostenedione were calculated and found to be elevated above the normal range. The excretion values for 11-deoxy-17-oxosteroids were highly variable, being below normal, normal or elevated in different patients. The excretion patterns in adrenocortical hyperplasia and carcinoma showed no characteristic differences; however, the patients with adrenal adenoma showed steroid excretions which suggested that these tumours secreted cortisol almost exclusively, together with small quantities of 11β-hydroxyandrostenedione, and minimal amounts of 11-deoxy-C19-steroids. The majority of patients excreted aetiocholanolone and androsterone in an abnormally high ratio; this also occurred after administration of androst-4-ene-3:17-dione, and it is suggested that in Cushing's syndrome the hepatic enzymes preferentially reduce adrenal androgen to metabolites with the 5β configuration.