STIMULATION AND SUPPRESSION OF THE ADRENAL CORTEX IN CUSHING'S SYNDROME

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Abstract
Stimulation tests have been performed on 26 patients with normal adrenal function, 23 hirsute women, 13 patients with Cushing's syndrome (liypcrplasia 11, adenoma 1, carcinoma 1), and 3 patients with hormone-secreting adrenocortical carcinoma without Cushing's syndrome. Suppression tests have been performed on 11 patients with Cushing's syndrome (hyperplasia 9, adenoma 1, carcinoma 1). Corticotropin-gel was used for stimulation and α fluorohydrocortisone for suppression. Response was assessed from changes in urinary 17-hydroxycorticosteroid and 17-ketosteroid excretion. In the stimulation tests an abnormal increase of urinary 7-hydroxycortieosteroid excretion was noted in 1 obese male, 1 normal male, 15 hirsute females and 7 of the patients with Cushing's syndrome due to adrenocortical hyperplasia. There was a moderate increase of urinary 17-hydroxycorticosteroids in the patient with an adenoma and a very slight increase in the patient with Cushing's sjaidrome due to a carcinoma. In 2 of the patients with adrenal carcinoma without Cushing's syndrome there was an increase of steroid excretion upon stimulation, suggesting that the tumor was influenced by corticotropin. In the suppression tests, 4 patients with adrenocortical hyperplasia had a reduction of urinary steroid excretion. There was no change in the other 5 patients with hyperplasia or in the 2 patients with adenoma or carcinoma. The following conclusions are drawn: 1) Obese hirsute women, not suffering from Cushing's syndrome, may have an abnormal increase of urinary 17-hydroxycorticosteroid excretion following administration of corticotropin. 2) In some cases of Cushing's syndrome due to hyperplasia there is only a modest increase of steroid excretion upon stimulation. 3) A positive result with the 9α-fluorohydrocortisone suppression test in a patient with Cushing's syndrome is good evidence that the condition is due to hyperplasia; a negative result has no significance. 4) In Cushing's syndrome due to hyperplasia, stimulation and suppression tests do not help in the recognition of cases subject to relapse after subtotal adrenalectomy.