Patterns of urinary excretion of steroids in Cushing's syndrome.

Abstract

In the differential diagnosis of 20 patients with Cushing's syndrome a marked increase in urinary neutral 17-KS excretion favored adrenocortical carcinoma, low values an adenoma, whereas ACTH and Metyrapone (Su-4885) hyper-responsiveness and dexamethasone suppressibility suggested nontumorous hyperplasia. None of the above, however, could be relied upon to establish the correct diagnosis unequivocally. Chromatographic separation of neutral 17-KS in 11 patients confirmed abnormal patterns of excretion of A, E, KE, OHE and OHA, but failed to prove of diagnostic value. DHEA was markedly elevated in 3 out of 3 patients with carcinoma as well as in one out of 3 with adenoma and 2 out of 5 patients with adrenocortical hyperplasia. One patient with an adenoma and one with hyperplasia had normal base line excretion but excessive ACTH responses. Two patients with hyperplasia associated with extra-adrenal neoplasia had normal DHEA excretion at all times. Urinary “pregnanediol” and “pregnanetriol,” determined as sul...