Urinary Excretion Of 17-hydroxycorticosteroids Research Articles

PSYCHOENDOCRINE ASPECTS OF ACUTE SCHIZOPHRENIC REACTIONS.

Four young male soldiers suffering from first-episode acute schizophrenic reactions were studied psychiatrically and endocrinologically over a period of months while they received milieu therapy for their illnesses. Independent of endocrine findings, the clinical course of each patient was classified into phases, in which special emphasis was given to periods designated “Acute Psychotic Turmoil,” “Psychotic Equilibrium”, “Anaclitic Depression,” and “Recovery.” Psychiatric phases characterized by a high degree of anxiety or depression were found to be associated with marked elevations in urinary 17-hydroxycorticosteroid excretion--as high as 2–3 times normal. Conversely, output of corticosteroids dropped toward normal levels during “Psychotic Equilibrium” and “Recovery” periods, both these phases being characterized by relative emotional calm. These shifts in 17-hydroxycorticosteroid excretion (Turmoil > Psychotic Equilibrium < Depression > Recovery < Turmoil) were predicted, and were statistically highly significant. Epinephrine excretion tended to follow a similar pattern, with elevations as high as 8 times normal occurring during “Turmoil” phases. It is suggested that corticosteroids and epinephrine excretion may not be influenced by the type of psychological defenses employed by the patient in protecting himself from anxiety and depression, but rather by the effectiveness of the defenses, whether they be psychotic or neurotic. The potential uses of psychoendocrine techniques in clinical psychiatry are discussed.

STEROID AND CATECHOLAMINE STUDIES ON PILOTS DURING PROLONGED EXPERIMENTS IN A SPACE CABIN SIMULATOR.

Urinary excretion of 17-hydroxycorticosteroids, corticosterone-like hormones, and catecholamines (epinephrine and norepinephrine) has been investigated on pilots during prolonged experiments in a two-man space cabin simulator. The experimental profiles were: 1) two 17-day experiments at ground level; 2) two 14-day experiments at 27,000 ft; and 3) four experiments at 33,500 ft lasting 17 days. In the latter two groups the atmosphere was essentially 100% O2. The hormone parameters indicate that conditions imposed by the experimental procedures were no more stressful to the subjects than undergoing extensive medical examinations as observed from pre- and postexperimental values. The only significant trend was the continuous linear increase in the excretion of corticosterone-like hormones. There were borderline indications that the excretion of 17-hydroxycorticosteroids and norepinephrine were altitude dependent. Extraordinary occurrences in the simulator were correlated with increased catecholamine and steroid excretion. The correlation coefficients and the analyses of variance for the four hormone parameters were calculated and discussed. endocrinology; sealed environments; stress hormones Submitted on March 26, 1963

Corticosteroids in Rheumatoid Arthritis

The exact relationships between the secretory activity of the anterior pituitary-adrenal cortical system and the rheumatic disease states in man have not been completely delineated. Previous studies 1 have shown that while the daily urinary excretion of 17-ketosteroids in patients with rheumatoid arthritis did not differ from that seen in normal subjects, the excretion of urinary 17-hydroxycorticosteroids was slightly diminished from the mean level observed in normal subjects, due to a lower output during the early morning hours. Although these mean urinary steroid values in patients with rheumatoid arthritis differed slightly from those found in normal subjects, they were not significantly different from those seen in patients with nonrheumatic chronic illnesses. It has also been shown 2,3 that glucocorticoid and mineralocorticoid hormones exert distinctly different effects on connective tissue; indeed the observed effects of these hormones on inflamed tissues may be opposite. A possible relationship between these two groups of

TREATMENT OF ADRENOCORTICAL CANCER WITH O,P'-DDD.

Article1 July 1963Treatment of Adrenocortical Cancer with O,P′-DDDANTONIO DA SILVA COELHO NETTO, M.D., BERNARDO LÉO WAJCHENBERG, M.D., CASSIO RAVAGLIA, M.D., VIRGILIO GONÇALVES PEREIRA, M.D., JOSÉ SHNAIDER, M.D., ARMANDO AGUIAR PUPO, M.D., ANTONIO BARROS DE ULHOA CINTRA, M.D., PH.D.ANTONIO DA SILVA COELHO NETTO, M.D.Search for more papers by this author, BERNARDO LÉO WAJCHENBERG, M.D.Search for more papers by this author, CASSIO RAVAGLIA, M.D.Search for more papers by this author, VIRGILIO GONÇALVES PEREIRA, M.D.Search for more papers by this author, JOSÉ SHNAIDER, M.D.Search for more papers by this author, ARMANDO AGUIAR PUPO, M.D.Search for more papers by this author, ANTONIO BARROS DE ULHOA CINTRA, M.D., PH.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-59-1-74 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe initial observations of Nelson and Woodward (1, 2) that the feeding of the insecticide, 1,1-dichloro-2,2-bis (p-chlorophenyl) ethane (DDD) to dogs results in necrosis and atrophy of the adrenal cortex opened a new research field for adrenocorticolytic drugs. Brown et al. (3-5) observed that necrosis of the adrenal cortex was followed by a decrease in urinary excretion of 17-hydroxycorticosteroids. In these animals a picture compatible with adrenocortical insufficiency developed which was not modified by the simultaneous administration of adrenocorticotropic hormone (ACTH) but which could be prevented by cortisone.Other authors (6-8) confirmed these initial data and the technical grade DDD...

Urinary 17-hydroxycorticosteroid levels in parents of children with neoplastic disease: a study of chronic psychological stress.

Urinary 17-hydroxycorticosteroid (17-OHCS) excretion rates were determined in 43 subjects, representing one or both parents of 26 children with neoplastic disease. Twentynine of the parents were admitted for study to a National Institute of Mental Health ward while their children were hospitalized; 14 parents lived at home and were studied on an “outpatient” basis. In this situation of chronic psychological stress, repeated determinations on each parent showed that the 17-OHCS level tended to remain within a relatively constricted range, even when the parent was exposed to superimposed acute stress. The subjects were ranked according to their relative corticosteroid excretion rates, and adrenal cortical activity was hypothesized to be related to the effectiveness of the individual's coping behavior. The group data showed slight, but statistically significant, elevations at the time the parents were first admitted to the ward and when psychological stress was judged to be maximal. A statistically significant sex difference was observed, with mean values for the fathers and mothers of 7.3lmg./24 hr. and 5.0 mg./24 hr., respectively.

KLINISCH-EXPERIMENTELLE STUDIEN MIT MENSCHLICHEM HYPOPHYSÄREM GONADOTROPIN

ABSTRACT Gonadotrophin extracted from human hypophyses (HHG) was administered in clinical trials to 5 amenorrhoic women. Gonadotrophin levels in the blood and urine and the urinary excretion of oestrogen, pregnanediol, 17-hydroxycorticosteroids, 17-ketosteroids and pregnanetriol were determined before, during and after treatment. Clinical control methods included endometrial biopsy and vaginal smear examination. Following the i. m. administration of HHG the gonadotrophin excretion increased markedly within the first 24 hours. Plasma gonadotrophin increased to substantially higher levels within 4–6 hours after the first injection. After cessation of treatment both plasma and urine gonadotrophin concentration returned slowly within 2–4 days to the pre-treatment levels. Following treatment, all 4 patients with hypogonadotrophic amenorrhoea (primary pituitary insufficiency) responded by an increased oestrogen and pregnanediol production. It would seem therefore that HHG-treatment had succeeded in producing ovulation. The single case of hypergonadotrophic amenorrhoea (primary ovarian insufficiency) showed no response in this respect. No change in 17-OHCS excretion was effected by the HHG-treatment. Changes in 17-ketosteroids and pregnanetriol excretion did not show a constant pattern. The clinical effects obtained in the 4 hypogonadotrophic amenorrhoea cases are confirmed in that ovulation was induced by means of the treatment.

Urinary excretion of adrenal hormones in gonadal dysgenesis and its response to corticotrophin and gonadotrophin stimulation.

ABSTRACT The functional capacity of the adrenals was studied in eight adult patients with gonadal dysgenesis, ranging in age from 16–42 years, by measuring the 24-hour urinary excretion of 17-hydroxycorticosteroids (17-OHCS) and of 17-ketosteroids (17-KS) with the patient at rest and also by estimating its response to stimulation with corticotrophin and chorionic gonadotrophin. In six patients the clinical diagnosis of the syndrome was confirmed by laparotomy, when no gonads were found in five patients and a white fibrous band replacing the gonads was found in the other. The remaining two patients of the series both had male sex-chromatin. The resting excretion of both 17-OHCS and 17-KS was within normal limits in all eight patients. After corticotrophin stimulation (25 IU infused over 8 hours) an increased 17-OHCS excretion was found in all patients but the increase was less constant for the 17-KS. These results are identical with those expected from normal subjects and were considered to indicate a normal adrenal secretory capacity in the present cases. Stimulation by chorionic gonadotrophin (HCG test) was performed in four patients using various doses of the hormone, namely 1500 IU for 5 days, 5000 IU for 2 or 5 days, or 10 000 IU for 2 days. Three of these patients had no gonads and the fourth had male sex-chromatin. The HCG test failed to elicit an increased excretion of either 17-OHCS or 17-KS in these patients. This absence of response is regarded as evidence that HCG does not stimulate adrenal tissue to secrete the precursors of these hormones. The findings of the present study are discussed in the light of previous publications.

Effect of diphenylhydantoin on pituitary-adrenal interrelations.

ABSTRACT This report describes the effect of short-term administration of therapeutic amounts of diphenylhydantoin (Dilantin) on the adrenal cortical function in 8 normal adults. The integrity of the pituitary-adrenal axis was evaluated by measuring alterations in the urinary excretion of 17-hydroxycorticosteroids after oral administration of SU-4885 (Metopirone). Adrenal cortical responsiveness was assessed by determining the increase in plasma 17-hydroxycorticosteroid levels following intramuscular ACTH gel. These studies were performed before and during diphenylhydantoin administration. Before receiving diphenylhydantoin, all 8 subjects had a normal plasma 17-hydroxycorticosteroid response to intramuscular ACTH, and an increased urinary excretion of 17-hydroxycorticosteroids following the administration of SU-4885. While receiving diphenylhydantoin, the effect of ACTH was unaltered in all 8 subjects, whereas 7 subjects now manifested an abnormal response to SU-4885. In 3, this was characterized by a la...

Adrenal and urinary corticosteroids in terminal hepatic failure. Report of a case.

ABSTRACT Determinations of aldosterone (11β,21-dihydroxy-3,20-dioxo-pregn-4-en-18-al), and 17-hydroxycorticosteroids in the urine and adrenals of a patient dying from hepatic insufficiency were made. In spite of an abnormally high terminal concentration in the urine of aldosterone extractable at pH 1.5, the adrenal aldosterone content was found to be on the same level as in that of three normal subjects. The urinary excretion of 17-hydroxycorticosteroids was below the normal range, the fraction extractable at pH 7 being somewhat elevated, the glucuronide fraction, on the other hand, being comparatively low.

THE INFLUENCE OF 17α-METHYL-19-NORTESTOSTERONE (M. N. T.) ON THE METABOLISM OF CORTISOL

ABSTRACT The effect of prolonged 17α-methyl-nortestosterone (M. N. T.) administration on cortisol metabolism was studied in several patients. 1. A decreased urinary excretion of 17-hydroxycorticosteroids occurred regularly. 2. Chromatographic analysis of the urinary corticoids revealed that the decreased urinary excretion involved exclusively cortisol metabolites, whereas corticosterone metabolites were excreted at normal levels. This chromatographic study moreover showed an impairment in the conjugation of tetrahydrocorticoids. 3. Studies with 4-14C-cortisol in MNT treated patients showed increased transcortin levels, a normal cortisol pool, a reduced cortisol inactivation rate and a decreased cortisol production. 4. From these results it is concluded that the decreased 17-hydroxycorticoid excretion reflects a decreased cortisol production, at least partly secondary to a reduced cortisol-inactivation rate, which itself must be attributable either to an inhibition or a defect in the liver enzyme systems concerned in corticoid-inactivation.

Effect of norethandrolone on the urinary excretion of 17-ketosteroids, total 17-hydroxycorticosteroids and uropepsin and on the gastric secretory activity.

ABSTRACT The effect of orally administered 17α-ethyl-17β-hydroxy-19-norandrost-4-en-3-one (75 mg daily during 8 days) on the urinary excretion of 17-ketosteroids, total 17-hydroxycorticosteroids and uropepsin and on the gastric secretory activity has been studied in 10 male patients with peptic ulcers. The excretion of 17-ketosteroids was significantly reduced, but the excretion of total 17-hydroxycorticosteroids and uropepsin and gastric secretory activity were not affected by the treatment.

Therapeutic Doses of Salicylates

Introduction Similarities between the anti-inflammatory effects obtained from salicylate and glucocorticoid therapy in rheumatic diseases have led to speculation as to a common mode of action of these two substances. Metabolic studies using current laboratory procedures have, however, often produced conflicting results. Data have been reported supporting the concept that salicylates stimulate the pituitary-adrenal axis in man. In other studies these data have not been confirmed and, indeed, appear to have been contradicted. Some investigators have reported an increase in the urinary reducing steroids and no change in neutral 17-ketosteroids after salicylate therapy. 1-3 Others have reported a significant decrease in the urinary 17-hydroxycorticosteroid excretion with a slight decrease in 17-ketosteroid excretion in individuals who have been given large doses of salicylates. 4 Other reports have shown no significant alteration in either urinary 17-ketosteroids 5-7 or 17-hydroxycorticosteroids 6,7 following salicylate administration. In many of the earlier studies in man, massive

The influence of 17 alpha-methyl-19-nortestosterone on the endocrine function of the adrenal cortex.

ABSTRACT In two male patients and two castrated males, the influence of corticotrophin (ACTH) on the urinary excretion of neutral 17-ketosteroids and 17-hydroxycorticosteroids was determined before and during a period in which patients were treated with 5 mg 17α-methyl-19-nortestosterone (MNT) daily. In two castrated males, moreover, the influence of chorionic gonadotrophin and ACTH + chorionic gonadotrophin on the urinary excretion of 17-ketosteroids and 17-hydroxycorticosteroids was determined before and during a period of treatment with 5 mg MNT daily. Prolonged administration of MNT causes a decrease in the urinary excretion of neutral 17-ketosteroids and 17-hydroxycorticosteroids both in the normal males and in the male castrates. ACTH caused an increase in the urinary excretion of 17-ketosteroids and 17-hydroxycorticosteroids before and during MNT administration. During MNT administration this increase (expressed in mg/24 hours) was ≤ the increase produced by the same dose of ACTH prior to MNT administration. In two male castrates treated with MNT, chorionic gonadotrophin caused no increase in the urinary excretion of 17-ketosteroids and 17-hydroxycorticosteroids. The effect obtained before and during MNT administration by administration of ACTH + chorionic gonadotrophin did not exceed the effect obtained by the same dose of ACTH alone. Our conclusion is that the effect of MNT on the excretion of adrenocortical steroids is not due to the inhibition of the ACTH secretion. The possibility of a direct effect of MNT on the adrenal cortex has not been excluded with complete certainty. A change in the corticosteroid metabolism due to the influence of MNT, however, must also be taken into consideration.

The urinary excretion of 17-hydroxycorticosteroids by premature infants: comparisons between premature infants experiencing uneventful courses and those having clinical difficulty, including death.

Many premature infants die without an apparent clinical cause, often unexpectedly. Other premature infants who experience clinical difficulties demonstrate sufficient signs to alert the experienced clinician. Since, in premature infants, the normal values have not been established for many of the parameters that would be useful in judging the severity and extent of disease or dysfunction, it is often difficult or impossible to minister accurately to the needs of the patient. The adrenal cortex is an organ of complex biochemical activity whose normal function is essential to the health of human beings. It has been suggested that newborn premature infants normally produce a minimal amount of 17-hydroxycorticosteroids (17-OHCS). 1 At birth the mean values for urinary 17-OHCS were extremely low compared to those of normal adults, and they increased progressively during the first 40 days of life. Thus, there is evidence that in the newborn premature infant, adrenocortical function may

Studies on the urinary excretion of 5-hydroxyindolacetic acid and 17-hydroxycorticosteroids in patients treated with marsilid.

Studies on the urinary excretion of 5-hydroxyindolacetic acid and 17-hydroxycorticosteroids in patients treated with marsilid.

Adrenal Cortical Activity in Diabetes Mellitus

In order to obtain some informations about adrenal cortical activity in diabetics, I have observed the changes of glucocorticoids activity measured by urinary excretion of total 17-hydroxycorticosteroids (17-OHCS) in the course of the treatment of diabetics. Following results were obtained.1. Of 22 uncontrolled diabetics, not associated with diabetic ketosis and coma, 5 patients showed normal excretion of urinary 17-OHCS and 17 patients showed increased excretion of urinary 17-OHCS.2. Urinary 17-OHCS excretion was intimately correlated to the severity of diabetes.3. When diabetic states were controlled by insulin in 14 patients, 10 patients showed normal excretion of urinary 17-OHCS and 4 patients showed slightly increased excretion of urinary 17-OHCS. But urinary excretion of 17-OHCS in controlled state was lower than it before treatment in each case.4. By sulfonylurea therapy urinary excretion of 17-OHCS did not show decreasing tendency when diabetic states were well controlled.5. In the patients with cardiovascular complications, urinary excretion of 17-OHCS was lower than it of the patients without complications. This seemed to be attributable to the some severe patients who were found in uncomplicated patients.6. A patient with hyperthyroidism and 3 patients with acromegaly were all severe diabetic patients and showed highly increased excretion of urinary 17-OHCS before treatment. But urinary excretion of 17-OHCS decreased remarkably when the former treated by insulin and antithyroidal drug and the latter by insulin.7. 3 patients with diabetic ketosis and 3 with diabetic coma, those were considered to be the most severe state of diabetes, showed the most increased excretion of urinary 17-OHCS in all cases. Nevertheless, they decreased after recovery by insulin therapy.From these findings it may be concluded that adrenal cortical hyperactivity in diabetic patients is a derangement secondarily to the metabolic disturbances of diabetes mellitus, and insulin therapy is preferable to sulfonylurea therapy. No significant differences are found in adrenal cortical activity between the patients with cardiovascular complications and the patients without complications. But it is suspected that hyperadrenocorticism, when it persisted in long period, may play an important role on the pathogenesis of the cardiovascular complications.

ADRENAL FUNCTION IN ALLERGY

An evaluation of a schedule of intermittent prednisolone therapy in the treatment of 42 children with severe allergic disorders, who had failed to respond to ordinary allergic management, is presented. In 11 subjects the response was excellent; in 28, good; and in 3, poor. No serious complications were observed as a consequence of the method of treatment. Appraisal of adrenal function, as measured by a standardized test of response to adrenocorticotropin, was undertaken before and after the institution of therapy in the majority of the subjects. The mean urinary excretion of 17-hydroxycorticosteroids in the test observed after the introduction of therapy was significantly less than that prior to treatment. This suggests that the regimen of therapy employed impairs the adrenals' response to exogenous ACTH. The unresponsiveness of the adrenals was at least partly dependent upon the dosage of hormone administered. The effect of intermittent steroid therapy on the urinary excretion of adrenocortical steroids in 16 subjects is also reported. Some hypofunction of the adrenals, which is overcome only partially during the days hormones are withheld, is suggested by the data on 17-OHCS. There was no discernible effect on the urinary excretion of 17-KS. The indications for use of steroid therapy in allergic children and the implications of the findings in this study are discussed. Although a schedule of intermittent steroid therapy was found to be useful as an adjunct in the treatment of intractable asthma and atopic dermatitis, it should not be used as a substitute for conventional methods of treating allergic patients. The criteria for selection of patients and the precautions required in the administration of continuous hormone therapy, should also be applied in the use of intermittent hormone therapy.

Persistent lactation associated with pituitary tumor and hyperadrenal corticism: Successfully treated with pituitary radiation

A case of persistent lactation associated with a pituitary tumor and increased urinary excretion of 17-ketosteroids and 17-hydroxycorticosteroids is presented. Cessation of lactation and a return to normal steroid excretion was accomplished by radiation therapy to the pituitary. The possible relationship of persistent lactation to pituitary tumors, to prolactin or a mammotropic hormone, and to adrenalcortical function is discussed.

Urinary 17-hydroxycorticosteroids and 17-ketosteroids in castrated vs. intact men: supplementary comparisons in feeble-minded vs. mentally normal men.

The daily urinary excretion of 17-hydroxycorticosteroids (17-OHCS) and 17-ketosteroids (17-KS) was studied in 52 castrated men and 31 intact men, 23 to 81 years of age; all were in good health and living under a similar regimen in the same institution for the feeble-minded. Mean values for 17-KS tended to be lower in castrated than in intact men, and were markedly so when calculated per Kg. of body weight. The degree of variation in 17-KS excretion from subject to subject was greater in castrated than in intact men. In a few eunuchs, the titers of 17-KS were normal or elevated. Mean titers of 17-OHCS were similar in castrated and intact men at all ages. Age at castration or duration of the castrate state did not influence values for 17-OHCS or 17-KS excretion or the relative proportions of these two types of steroid. The relationship between titers of 17-OHCS and 17-KS in the same subjects was significant, both in the eunuchs and in the intact men. Among young adult intact males, the daily values for urinary 17-KS, but not 17-OHCS, were significantly lower in the feeble-minded than in those of normal mentality. With advancing age, the values for urinary 17-KS were reduced in the eunuchs, particularly when calculated per Kg. of body weight. That aging is associated with declining titers of 17-KS in eunuchs, strongly suggests that adrenocortical secretions participate to a major extent in this phenomenon.

Metabolic Studies in Orthopaedic Patients

1. The four patients who underwent orthopaedic procedures were in negative nitrogen balance well below the dietary levels recommended by Rhoads, while the two patients who maintained a high nitrogen and caloric intake per kilogram of body weight were either in positive nitrogen balance or showed transient and minimal nitrogen deficits. It is of interest to note that, with the exception of F. G. (Fig. 2), all the patients showed fluctuations in weight and nitrogen balance that fairly well paralleled their dietary intake. 2. There was no correlation between the nitrogen deficits and the urinary excretion of 17-hydroxycorticosteroids. 3. It therefore appears from these studies that factors other than trauma to bone and adrenal overactivity are of major importance in governing the patient metabolic response. The factors which must be considered are: nutritional intake, fever, immobilization, and the preoperative nutritional status of the patient.