STUDIES IN PATIENTS WITH ADRENOCORTICAL HYPERFUNCTION. I. THE EFFECT OF CORTICOTROPIN ON LEVELS OF CORTICOSTEROIDS, 17-KETOSTEROIDS AND ALDOSTERONE*

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Abstract
Fourteen patients with Cushing's syndrome and 10 patients with a predominantly virilizing syndrome were studied and compared to a series of healthy subjects. Measurements ofurinary corticosteroids, 17-ketosteroids and aldosterone and of plasma corticosteroids were carried out while the patients were untreated, while they were receiving intramuscularinjections of ACTH over a 48-hour period, and following the withdrawal of ACTH. The results indicate that, after ACTH stimulation, the return of adrenocortical function to prestimulation levels is often delayed in patients with adrenocortical hyperfunction due to hyperplasia, as compared to normal subjects. This effect is best demonstrated by the 48-hourvalue of the plasma corticosteroids. Five-day suppression tests with 9α-fluorohydrocortisone were carried out in 10 patients. A rough correlation was observed between the responsiveness of a patient to this drug and the responsiveness of the same patient to ACTH. Initial observations with oxylone in 2 patients showed an effective suppression of both theurinary corticosteroids and the 17-ketosteroid values. The excretion of aldosterone was within the normal range in most of the patients. On administration of ACTH it increasedin the patients to a degree similar to that in the healthy subjects.