Cushing' Syndrome with Hypoglycemia Caused by Adrenocortical Carcinoma

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Abstract
The thirteenth case of hypoglycemia associated with an adrenocortical carcinoma is reported. Preoperative levels of plasma insulin-like activity were nor - mal by the rat epididymal fat-pad assay. Urinary 17-ketosteroids and 17-hydroxycorticoids, as well as plasma and urinary cortisol, were markedly elevated. The 17-ketosteroid fractionation showed markedly increased dehydroepiandrosterone, androsterone and etiocholanolone. Leucine, tolbutamide and manganese failed to produce hypoglycemia. At operation a 1450-g adrenocortical tumor was found. Arterial-venous blood glucose differential across the tumor was small. It is suggested that greatly increased secretion of anabolic steroids may channel amino acids into protein synthesis, thus making amino acids unavail- able for gluconeogenesis. It is postulated that in adrenal abnormalities associated with steroid hypersecretion either hypo- or hyperglycemia may be produced, depending upon the relative proportions of catabolic and anabolic compounds secreted.