Urinary cortisol excretion as a test of adrenal cortical function

Abstract

Urinary Cortisol excretion rates have been measured before and during ACTH administration in normal subjects and in patients having or suspected of having adrenal cortical abnormalities. Patients with the following disorders were included in the study; Cushing's syndrome, idiopathic hirsutism, Stein-Leventhal syndrome, exogenous obesity, hypopituitarism, and Addison's disease. Patients with Cushing's syndrome had baseline Cortisol excretion rates 10 to 800 times the normal baseline values. This was true in some cases even though the baseline 17-ketogenic steroid excretion rates were normal or only slightly elevated. Those patients studied had a noticeably greater response than normal to ACTH, and in 2 patients the excessive excretion rate of Cortisol above their high baseline values continued for 1 or more days after intravenous ACTH was discontinued. The patients with adrenal-cortical adenomas had brisk increases in urinary Cortisol excretion rates during ACTH. Patients with “idiopathic” hirsutism had a greater than normal response to ACTH as measured by urinary Cortisol excretion rate. Two of 4 patients with Stein-Leventhal syndrome showed relatively little increase in urinary Cortisol excretion in response to ACTH. Ovarian resection in 1 patient had no influence on the responsiveness to ACTH; however, administration of estinyl estradiol for 2 weeks resulted in a normal increase in urinary Cortisol excretion in response to ACTH. Patients with exogenous obesity had normal baseline excretion rates of urinary Cortisol and the response to ACTH was normal.