Urinary excretion of corticosterone metabolites in demonstrating the adrenocortical remnant

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Abstract
The spontaneous excretion and the secretory reserve of corticosterone and its metabolites (total B) after bilateral adrenalectomy were determined at an early postoperative date in 22 patients with ACTH-dependent Cushing's syndrome. On the basis of these early results two groups of patients could be distinguished. Group I comprised 19 patients with an immeasurable or negligible excretion, unresponsive to ACTH. The patients of this group exhibited lasting remission. Group 2 comprised the remaining 3 patients who had an abnormally high spontaneous excretion and/or an abnormally high secretory reserve. Primary remission was merely transitory or failed to appear. All the patients in this group exhibited residual adrenocortical tissue at reoperation or at autopsy. At follow-up the biochemical investigation was repeated. The early results proved to be a reliable indication of the excretion pattern throughout the follow-up period (mean 5 years). It is concluded that determination of urinary total B excretion early after bilateral adrenalectomy is valuable in assessing whether the adrenalectomy was total or whether residual adrenocortical tissue was left. In patients with Cushing's syndrome associated with adrenocortical hyperplasia the test was also reliable in predicting the probability of subsequent primary long term remission.