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EDWIN J. KEPLER, HAROLD L. MASON, RELATION OF URINARY STEROIDS TO THE DIAGNOSIS OF ADRENAL CORTICAL TUMORS AND ADRENAL CORTICAL HYPERPLASIA: QUANTITATIVE AND ISOLATION STUDIES, The Journal of Clinical Endocrinology & Metabolism, Volume 7, Issue 8, 1 August 1947, Pages 543–558, https://doi.org/10.1210/jcem-7-8-543
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Abstract
CLINICAL pictures which accompany functioning tumors of the adrenal cortex are neither specific nor diagnostic. Other pathologic conditions produce similar or even identical symptoms. Only one of these other conditions need be mentioned here; namely, adrenal cortical hyperplasia.* For therapeutic reasons it is very important to distinguish cases of adrenal cortical tumor from adrenal cortical hyperplasia and from the other clinical and pathologic entities which simulate both of them. The discussion that follows centers around the chemical and biologic methods that can be employed to help make these distinctions.
Urine of patients who have functioning adrenal cortical tumors usually contains excessive amounts of both androgens and 17-ketosteroids. The former can be determined only by biologic methods, whereas the latter, which include not only androgenic steroids but others which seem to be biologically inert, can be determined by chemical methods. Kenyon, Gallagher, Peterson, Dorfman and Koch (1937) (27) were among the first to demonstrate that there may be large amounts of androgenic material in the urine excreted by patients having these tumors. They studied fifteen cases of “virilism” among women. Twelve patients excreted normal amounts of androgens, two excreted 25 per cent more than normal and one, who had a carcinoma of the adrenal cortex, excreted very large amounts. Similar observations were made by R. K. Callow (1938) (11). He determined both the androgen and the 17-ketosteroid content of the urine. In his series of cases there was one woman who had Cushing's syndrome, also a girl aged nineteen years who had an adrenal cortical tumor, and several women who were virilized but who presumably did not have adrenal cortical tumor. Only in the case of adrenal tumor was there found an increase of the urinary content of both androgenic and 17-ketosteroidal material. Callow therefore came to the conclusion that “adrenal tumor can be diagnosed with the aid of androgen assay.” Levy Simpson (1938) (31), however, in a discussion of Callow's paper, pointed out that Callow's conclusion should be qualified since, in Levy Simpson's experience, the urine of patients having adrenal cortical hyperplasia sometimes contained amounts of androgenic material comparable to those obtained in cases of adrenal cortical tumor.
