RELATION OF URINARY STEROIDS TO THE DIAGNOSIS OF ADRENAL CORTICAL TUMORS AND ADRENAL CORTICAL HYPERPLASIA: QUANTITATIVE AND ISOLATION STUDIES

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Abstract
The total 17-keto-steroids and the 3[beta]-alcoholic fractions were determined in 6 cases of adrenal cortical tumor and 5 cases of cortical hyper-plasia. Individual steroid compounds were isolated in 6 cases of tumor and 4 of hyperplasia. The isolation and quantitative studies agreed in the finding of an increased 3[beta]-alcoholic fraction (dehydroisoandrosterone) in most cases of tumor. Total values ranged from 68-1,005 mg. and the [beta]-fraction from 48-77%. However, in one case of tumor the 17-ketosteroids were less than normal. They were moderately elevated in another case with only 7.5% of [beta]-fraction. In hyperplasia, the [beta]-fractions were 2-20% of the total values which ranged from 10-123 mg. It appeared that excretion of 50 mg. or more of 17-ketosteroids with a [beta]-fraetion of 50% or more strongly indicated the presence of a tumor. The amount of androsterone was increased, particularly in hyperplasia, and the amount of etiocholanolone was increased in cases of tumor. A new 17-ketosteroid, androstane-3([alpha]),11-diol-17-one, was isolated in 3 cases of tumor and all cases of hyperplasia. Pregnanediol was isolated in almost all cases studied and pregnane-3([alpha]),17,20-triol was isolated in 1 case of tumor and 3 cases of hyperplasia. Estrone was isolated from the urine of the only case of tumor in which an excessive amt. of estrogen was excreted. The results are discussed with reference to the clinical diagnosis of adrenal cortical tumor or cortical hyperplasia.