Determination of 17-hydroxycorticosteroids in dialysate solution as a measure of adrenocortical function in hemodialysis patients.

Dialysate contents of 17-hydroxycorticosteroids (17-OHCS) in hemodialysis patients were studied as a potential measure of adrenocortical function. Dialysate 17-OHCS contents after a 2-day interval of hemodialysis in 15 hemodialysis patients were determined. Dialysate 17-OHCS increased after intravenous injection of cortisol the evening prior to hemodialysis (n = 4). Dialysate 17-OHCS content was suppressed, as was plasma cortisol, after a standard dexamethasone (Dex) suppression test (n = 1). Their plasma cortisol was suppressible or nonsuppressible by an overnight Dex suppression test, as reported previously. However, basal dialysate 17-OHCS contents were not different between them, indicating that the nonsuppressible patients with overnight Dex seem not to have hypercortisolism. We conclude that determination of dialysate 17-OHCS seems a useful noninvasive technique for the evaluation of adrenocortical function in hemodialysis patients.

Identification of, and development of radioimmunoassays for 17 alpha, 21-dihydroxy-4-pregnene-3,20-dione and 3 alpha,17 alpha, 21-trihydroxy-5 beta-pregnan-20-one in the ovaries of mature plaice (Pleuronectes platessa).

Ovaries from a female plaice (Pleuronectes platessa) that had been injected with human chorionic gonadotrophin were incubated in vitro with 17 alpha-hydroxy[1,2,6,7-3H]progesterone. The major steroids produced by the ovaries were tentatively identified as 17 alpha,21-dihydroxy-4-pregnene-3,20di-one (11-deoxycortisol; 17,21-P), 17 alpha,21-dihydroxy-5 beta-pregnane-3,20-dione (3 alpha, 17,21-P-5 beta). A high proportion of these steroids was found in a conjugated form (sulphates or glucuronides). Radioimmunoassays were developed for 11-deoxycortisol and for 3 alpha,17,21-P-5 beta and were applied to fractions of mature male and female plaice plasmas and plaice ovarian incubates that had been separated on thin-layer chromatography. The presence of all three steroids, in vivo and in vitro, was confirmed. Particularly high amounts of conjugated 3 alpha,17,21-P-5 beta were found in the plasma of mature females (200-400 ng ml-1). The 3 alpha,17,21-P-5 beta radioimmunoassay also identified 3 alpha,17 alpha-dihydroxy-5 beta-pregnane-20-dione in all three fluids, despite the fact that this steroid was not among the radioactive incubation products of the ovary. These findings are compared with those from another flatfish, the dab (Limanda limanda), where the major gonadal steroids have been shown to be 17 alpha,20 alpha-dihydroxy-4-pregnen-3-one and its 5 beta-pregnane (3-keto and 3 beta-hydroxyl) metabolites.

[21-deoxycortisol. A new marker of virilizing adrenal hyperplasia caused by 21-hydroxylase deficiency]. / Le 21-désoxycortisol. Un nouveau marqueur de l'hyperandrogénie surrénalienne par déficit en 21-hydroxylase.

21-deoxycortisol is a steroid produced mainly by the adrenal gland. Its normal plasma baseline concentrations (0.03 to 0.30 n/ml) and its concentrations after tetracosactide injection (0.15 to 0.76 ng/ml) do not significantly vary with age, sex and phases of the menstrual cycle. 21-deoxycortisol was assayed in plasma by a specific radioimmunological method and its values were compared with those of 17-OH progesterone in heterozygous subjects with the classical and non-classical forms of 21-hydroxylase deficiency, and in the amniotic fluid of foetuses with this deficiency. Baseline concentrations of 21-deoxycortisol in the classical forms of 21-hydroxylase deficiency (n = 12; 55.36 to 186.6 ng/ml) and post-tetracosactide concentrations in non-classical late onset forms (n = 31; 4.04 to 47 ng/ml) were much higher than in normal subjects, thus making this steroid as sensitive as, or even more sensitive than 17-OH progesterone in diagnosing 21-hydroxylase deficiency. Post-tetracosactide assays of 21-deoxycortisol in 84 heterozygous subjects with 21-hydroxylase deficiency (0.70 to 5.40 ng/ml) enabled these subjects to be detected with a more than 90 percent sensitivity, which cannot be obtained with 17-OH progesterone assays. 21-deoxycortisol concentrations in the amniotic fluid of foetuses with 21-hydroxylase deficiency (n = 11; 0.391 to 0.930 ng/ml) were constantly superior to those observed in normal foetuses (n = 38; 0.034 to 0.221 ng/ml), so that the deficiency can be diagnosed with the steroid as easily as with 17-OH progesterone.

Prenatal diagnosis of 21-hydroxylase deficiency congenital adrenal hyperplasia by simultaneous radioimmunoassay of 21-deoxycortisol and 17-hydroxyprogesterone in amniotic fluid.

Amniotic fluid levels of 21-deoxycortisol (21-DOF) and 17-hydroxyprogesterone (17-OHP) were measured in 49 pregnancies, including 31 pregnancies at risk for CAH. The results were compared with those obtained by HLA typing and linkage analysis to a HLA DNA probe. The mean amniotic fluid levels in the control pregnancies were 0.28 nmol/L for 21-DOF and 4.1 nmol/L for 17-OHP. The levels were similar in early and midpregnancy for 21-DOF (0.29 vs. 0.27 nmol/L) and 17-OHP (3.4 vs. 4.2 nmol/L). The amniotic fluid 21-DOF level was 1.75 nmol/L in affected pregnancies, significantly higher than in the control pregnancies (mean, 0.28 nmol/L). The mean amniotic fluid 17-OHP level in the affected pregnancies (30.5 nmol/L) also was significantly higher than that in the control pregnancies (4.10 nmol/L). Simultaneous measurement of 21-DOF and 17-OHP levels in amniotic fluid from 10-18 weeks of gestation can be used for early diagnosis of congenital adrenal hyperplasia.

The functional state of adrenal cortex in patients with chronic relapsing pancreatitis.

The functional state of the adrenal cortex (cortisol and 11-OCS in blood, 17-OCS in 24-hours' urine) was studied in 105 patients with chronic relapsing pancreatitis in the acute state. An increase of adrenal cortex glucocorticoid activity was determined in 46.7% of the patients. A decrease of glucocorticoid activity was observed in 10% of the patients. During remission a tendency towards hormone normalization was noted in most of the patients, except for 5 patients with marked exocrine pancreatic insufficiency in whom the hormone content of adrenal cortex remained low. The type of pancreatitis as well as the severity and duration of the disease were noted to exert no regular impact upon the changes of the indices. Since exacerbation of chronic pancreatitis is frequently accompanied by elevated glucocorticoid activity of the adrenal cortex, the prescription of glucocorticoid hormones in such patients seems undesirable. The administration of such hormones is possible only for the patients with exocrine pancreas insufficiency.

Gynecomasty: estrogen and androgen receptors. A clinical-pathological investigation.

The histology, estrogen (ER)- and androgen (AR)- receptor content, s-FSH, s-LH, s-17-beta-estradiol, U-17-ketosteroid and U-17-ketogenic steroid patterns were measured in a consecutive series of 20 patients operated on for gynecomasty. Two out of 22 specimens were ER-positive, and 4 out of 22 were AR-positive. No relationship was demonstrated between the histopathologic features, ie. active-intermediate-inactive gynecomasty, and the steroid receptor content in the present limited number of cases. In addition, there was no marked relationship between the histopathologic features and the hormone values.

Polarization fluoroimmunoassay of 11-deoxycortisol in serum and saliva.

We developed polarization fluoroimmunoassays for 11-deoxycortisol in serum and saliva. To avoid interfering factors, the steroid was initially extracted from the biological fluids with dichloromethane. Assays could then be completed without any further separation procedures or need to correct for blank signals. The serum assay was suitable for following the response to the metyrapone test and results correlated acceptably with those by an established, specific, direct 125I-radioimmunoassay. The method is not sufficiently sensitive to detect 11-deoxycortisol in normal saliva, but greatly increased concentrations were found in post-metyrapone saliva and results agreed well with those by the radioimmunoassay as modified for salivary assay. Salivary 11-deoxycortisol assay would provide a convenient means of monitoring results of the metyrapone test.

[Insulin and 17-oxycorticosteroids in unfertilized eggs and in embryos of the loach]. / Insulin i 17-oksikortikosteroidy v neoplodotvorennykh iaitsekletkakh i zarodyshakh v'iuna.

Loach eggs are stated to possess some quantities of insulin or insulin-like substances with a positive reaction to antiinsulin antiserum. The level of these components is five times as high 30 minutes after fertilization, and does not change for the next 20 hours of the embryo development. No 17-oxycorticosteroids were detected in loach eggs and embryos during first four hours of the development; they appeared only at the blastula stage and at the state of gastrula their level increases considerably. It is supposed that insulin or insulin-like substances participate in metabolism regulation and cell differentiation of fish embryos during early stages of embryogenesis.

Cortisol, 11-desoxycortisol, and 21-desoxycortisol concentrations in amniotic fluid during normal pregnancy.

Concentrations of unconjugated cortisol, 11-desoxycortisol, and 21-desoxycortisol were measured by radioimmunoassay in amniotic fluid throughout gestation. Cortisol levels rose from a median of 6.5 nanograms per milliliter prior to 20 weeks to 13.9 ng/ml at 28 to 37 weeks. Median levels of 11-desoxycortisol and 21-desoxycortisol were 2.6 ng/ml and 0.21 ng/ml, respectively, and did not change with advancing gestation. These normal values provide a basis for the application of assays of 11-desoxycortisol and 21-desoxycortisol in amniotic fluid in the prenatal diagnosis of congenital adrenal hyperplasia.

11-deoxycortisol in amniotic fluid: prenatal diagnosis of congenital adrenal hyperplasia due to 11 beta-hydroxylase deficiency.

The mean control level of 11-deoxycortisol as determined by radioimmunoassay in eighty-one human amniotic fluid samples was 1.20 +/- 0.07 ng/ml. Markedly elevated levels were found at term in amniotic fluid of two pregnancies with fetuses affected with 11 beta-hydroxylase deficiency, congenital adrenal hyperplasia (135.0 and 64.0 ng/ml respectively) as well as in the maternal serum of one of these cases (28.0 ng/ml). It is suggested that the determination of 11-deoxycortisol in amniotic fluid be a prenatal diagnostic test for 11 beta-hydroxylase deficiency congenital adrenal hyperplasia.

[Endocrinologic and ophthalmologic findings before and after transnasal surgery in so-called chromophobe pituitary adenomas]. / Endokrinologische und ophthalmologische Befunde vor und nach transnasaler Operation bei sogenannten chromophoben Hypophysenadenomen.

Pre- and postoperative visual and endocrine functions were examined in 54 patients with so-called chromophobe pituitary adenomas operated on by the transnasal approach. The preoperative examination showed visual disturbances in 41 of 48 patients. A loss of gonadal function was present in 93% of the women and 69% of the men. Impairment of adrenal function was found in 37% and of thyroid function in 18% of patients. Hyperprolactinemia was present in 16 of 29 patients examined. The visual findings remained unchanged, normal or improved in 75% of patients. Impairment occurred in 3%. Eight patients experienced improvement of gonadal function and 3 of adrenal function, whereas no postoperative improvement of the thyroid function was observed. Deterioration of gonadal function occurred in 4, of adrenal function in 7, and of thyroid function in 9 patients. Hyperprolactinemia was reduced in all cases.