Studies in man on testicular and adrenal response to adrenocorticotropin and human chorionic gonadotropin.

Abstract

The present study compares, in the same 17 subjects with normal adrenocortical and testicular function, the response of the urinary total 17-hydroxycorticosteroids and 17-ketosteroids to the slow intravenous administration of adrenocorticotropin (ACTH) and human chorionic gonadotropin (HCG). In addition, 6 patients with Addison’s disease, bilateral orchiectomy, bilateral orchiectomy and adrcnalectomy, and primary and secondary hypogonadism were studied in order to evaluate: 1) the effect of HCG on adrenocortical secretory activity, 2) the relative contributions to urinary steroid output made by the adrenal cortices and testes, 3) the possible usefulness of changes in urinary 17-ketosteroid excretion as a rapid test of testicular interstitial-cell function, 4) the dose-response effect of intravenously administered HCG, 5) the effect of estrogens and androgens on the excretion of 17-hydroxycorticosteroids and 17-ketosteroids, and 6) the possible synergistic effect of ACTH and HCG on the excretion of these steroids. The results indicate that intravenous administration of HCG, even in large doses, does not lead to increased urinary excretion of total hydroxycorticosteroids. In addition, there is an obvious difference between the patterns of increased urinary 17-ketosteroid excretion following administration of ACTH as compared with HCG. This difference suggests that HCG does not stimulate the adrenal cortex in a manner similar to ACTH. The rapid and significant increase in 17-ketosteroid excretion in normal subjects and the slight increase in the patient with panhypopituitarism are in contrast to the lack of increase in patients with primary hypogonadism. This points to the possible usefulness of this procedure in distinguishing primary from secondary hypogonadism, and in studying testicular interstitial-cell function. Administration of estrogens or androgens does not modify the urinary corticoid levels, and there is no apparent synergism between HCG and ACTH.