17-ketosteroids and Adenoma

To clarify the indication of surgery in incidentally discovered asymptomatic adrenal masses, we analyzed 386 Japanese cases, 379 cases reported in Japan during the past 25 years (from 1964 to 1988) and 7 cases from our own experience. From a total of 460 patients, we carefully selected 379 patients satisfying our criterion of the absence of symptoms and signs suggestive of active hormone over-secretion as described in each case report. From the Japanese series, there was a high incidence of pheochromocytoma patients (20 of 37 patients) who had no symptoms and signs but had high plasma or urine catecholamines. Scintigraphy with 131I-meta-iodo-benzyl-guanidine was useful in the diagnosis of pheochromocytoma. For the other asymptomatic adrenal tumors, except for myelolipoma and adrenal cyst, differential diagnosis between malignant and benign adrenal lesions by imaging procedures such as whole body computed tomography (CT), ultrasonography (US), adrenocortical scintigraphy, and angiography was not always possible. In addition, among the 109 patients with cortical tumors whose hormonal data were reported, no clear-cut differentiation of malignant tumor from benign by means of these data could be obtained. Since 1980 whole body CT scanner and high resolution US scanner have become widely available, and there have been 283 cases of asymptomatic adrenal tumors who satisfied our criterion. Cortical carcinomas smaller than 3 cm and 6 cm in diameter account for 3.8% and 6.6%, respectively, of the total of 101 cases of cortical carcinoma, cortical adenoma, ganglioneuroma, and hemangioma during this period. The size of the smallest cortical carcinoma with metastasis was 2 cm in diameter in this series. Pre-operatively, an adrenocortical carcinoma 2.8 cm in diameter in our patient could not be diagnosed as such by imaging techniques and measurement of plasma hormones. These findings suggest that an adrenal mass larger than 3 cm should be removed and a patient with a smaller cortical tumor should be carefully followed up.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Aged; Aldosterone; Androstenedione; Corticosterone; Dehydroepiandrosterone; Female; Humans; Hydrocortisone; Male; Middle Aged; Renin; Tomography, X-Ray Computed; Ultrasonography; Vanilmandelic Acid

Three cases of virilizing tumors of the adrenal gland are reported. Two were malignant and are briefly summarized, and the other was benign. A review of the literature concerning benign virilizing tumors of the adrenal is included.

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Female; Humans; Middle Aged; Time Factors

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adult; Female; Humans; Hydrocortisone; Testosterone

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenocorticotropic Hormone; Adult; Androgens; Carcinoma; Child, Preschool; Cushing Syndrome; Estrogens; Female; Feminization; Glucocorticoids; Granulosa Cell Tumor; Humans; Leydig Cell Tumor; Male; Mesenchymoma; Middle Aged; Mitotane; Ovarian Neoplasms; Paraneoplastic Endocrine Syndromes; Pregnancy; Progesterone; Prognosis; Sertoli Cell Tumor; Steroids; Testicular Neoplasms; Thecoma; Virilism

Eight cases of adrenocortical tumor are presented with a review of the literature. Although such tumors are rare, they are important causes of inappropriate virilization and Cushing's syndrome in childhood. Clinical virilization with or without hypercortisolism was found in all eight children, who were 5 years old or younger. Excessive linear growth was noted, despite evidence of hypercortisolism. Serum levels of dehydroepiandrosterone, dehydroepiandrosterone sulfate, testosterone, and cortisol were elevated in all cases tested and appear to be useful diagnostic alternatives to the more traditional determinations of urine 17-ketosteroids and 17-hydroxycorticosteroids. Abdominal sonography and computed tomography have proven to be reliable tools for tumor localization. Surgical resection was the definitive therapy in all patients, and perioperative steroid replacement was essential. Histologic diagnosis appeared to have little bearing on prognosis, and the majority of pediatric patients have had clinically benign disease. At a mean follow-up of 3 years, seven of the eight children were alive and had no evidence of tumor recurrence.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenocarcinoma; Adenoma; Adrenal Cortex Neoplasms; Child, Preschool; Cushing Syndrome; Dehydroepiandrosterone; Female; Follow-Up Studies; Humans; Hydrocortisone; Infant; Male; Puberty, Precocious; Testosterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Air Pollution; Animals; Environmental Exposure; Eye Diseases; Guinea Pigs; Humans; Lung Neoplasms; Mice; Morbidity; Mortality; Mucous Membrane; Nitrates; Odorants; Ozone; Pulmonary Alveoli; Rats; Respiratory Function Tests; Respiratory Tract Diseases; Stress, Physiological; Time Factors; Vision Disorders; Visual Perception

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Androgens; Estrogens; Female; Gonadotropins; Hormones; Humans; In Vitro Techniques; Metabolism; Steroids; Virilism

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Aged; Blood Chemical Analysis; Carcinoma; Clinical Trials as Topic; Cushing Syndrome; Female; Humans; Hyperplasia; Male; Metyrapone; Middle Aged; Pregnanes

Topics: 17-Ketosteroids; Acetates; Adenoma; Androgen-Insensitivity Syndrome; Androgens; Androsterone; Carbon Isotopes; Chemistry, Clinical; Chromatography, Paper; Clinical Trials as Topic; Cushing Syndrome; Etiocholanolone; Female; Hirsutism; Humans; Hyperaldosteronism; Male; Methods; Myoma; Puberty, Precocious; Testosterone; Tritium; Uterine Neoplasms

A patient with adrenocortical carcinoma presented with fever, leukocytosis, and increased acute phase reactants. The tumor was infiltrated with neutrophils. Immunohistochemical staining of the tumor showed positive signal for epithelial neutrophil-activating protein-78, an angiogenic and chemotactic CXC chemokine. Conditioned medium from tumor-derived cells (RL-251) showed high concentration of IL-8, epithelial neutrophil-activating protein-78, Gro alpha, and Gro gamma, angiogenic CXC chemokines with a potential role in tumorigenesis. An adrenal cancer/severe combined immunodeficiency mouse chimera was developed. Mice grew tumors rapidly, and circulating levels of IL-8 and epithelial neutrophil-activating protein-78 were detected. In contrast, animals transplanted with NCI-H295 cells, a nonchemokine-secreting cell line, grew tumors more slowly and did not have detectable chemokine levels. Similar to the patient, mice with RL-251 tumors developed marked leukocytosis and neutrophilia, and their tumors were infiltrated with neutrophils. Mice were passively immunized with epithelial neutrophil-activating protein-78 antisera. A marked decrease in tumor growth was observed. Potential for chemokine production by other adrenocortical tumors was investigated by RT-PCR in archival material. Six of seven adrenal carcinomas and one of three adenomas had cDNA for IL-8; six of seven carcinomas and the three adenomas had cDNA for epithelial neutrophil-activating protein-78. We concluded that the clinical presentation of this case resulted from increased tumor production of chemotactic chemokines. Through their angiogenic and chemotactic properties these chemokines may play an important role in adrenal tumorigenesis.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenocorticotropic Hormone; Aged; Chemokine CXCL5; Chemokines, CXC; Circadian Rhythm; Fever; Humans; Hydrocortisone; Immunohistochemistry; Interleukin-8; Leukocytosis; Male; Neutrophil Activation; Neutrophils; Reverse Transcriptase Polymerase Chain Reaction; Syndrome; Tumor Cells, Cultured

Transsphenoidal adenomectomy is currently the first choice for treatment of patients with pituitary ACTH-dependent Cushing's syndrome. However, pharmacotherapy is prescribed for some patients, e.g., unsuccessful surgery. We treated a woman in whom pituitary Cushing's syndrome was improved while she was on antimuscarinic cholinergic agents, atropine sulphate and pirenzepine hydrochloride. The diminished effect of anticholinergics on ACTH and cortisol was incidentally identified in an inferior petrosal sinus sampling procedure. A single intramuscular injection of atropine significantly decreased both ACTH (43.9 pg/ml to less than 12.0; normal, 12.0-40.0 pg/ml) and cortisol (29.9 microg/dl to 13.6; normal, 7.6-23.6 microg/dl). An M1-muscarinic receptor specific antagonist, pirenzepine hydrochloride, also had a diminishing effect on these hormones and this inhibiting effect was partially blocked by the simultaneous administration of an anticholinesterase agent, pyridostigmine bromide. Chronic oral ingestion of these agents led to improvement in clinical symptoms, and urinary 17-hydroxycorticosteroid and 17-ketosteroid levels were at normal to upper-normal levels. This is the first documentation of involvement of the cholinergic system in the pathogenesis of pituitary Cushing's syndrome.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenocorticotropic Hormone; Atropine; Choline; Cushing Syndrome; Dexamethasone; Female; Humans; Hydrocortisone; Metyrapone; Middle Aged; Muscarinic Antagonists; Petrosal Sinus Sampling; Pirenzepine; Pituitary Neoplasms

An adrenocortical adenoma causing Cushing's syndrome (Cushing's adenoma) produces a unilateral concordant visualization (UCV) imaging pattern in which the adenoma is only visualized on radioiodocholesterol adrenocortical scintigraphy. But because this imaging pattern is also noted in some patients with adrenal incidentalomas, we examined whether the UCV-incidentaloma was essentially identical with Cushing's adenoma and would develop Cushing's syndrome. The subjects were 9 patients with UCV-incidentalomas (mean size, 30 mm; range, 20-45 mm) and 6 patients with Cushing's adenomas (mean size, 28 mm; range, 25-35 mm). Endocrinological evaluations showed several abnormalities including blunted diurnal rhythm of plasma cortisol within the normal range, low plasma ACTH and/or high 24-hr urinary 17-OHCS levels in 8 of 9 patients with UCV-incidentalomas, but these abnormalities did not meet the diagnostic criteria of Cushing's syndrome. Adrenal uptake of the tracer in the patients with UCV-incidentalomas was not statistically different from that in the patients with Cushing's adenomas and had no relationship with hormonal values in either patient group. Tumor size on CT correlated with the levels of 24-hr urinary 17-OHCS (r = 0.75, p = 0.02) and plasma cortisol at 7:00 (r = 0.82, p = 0.007) in the patients with UCV-incidentalomas, but not in the patients with Cushing's adenomas. Although 3 UCV-incidentalomas increased slightly in size, none of 9 patients with UCV-incidentalomas has developed Cushing's syndrome for 4 to 52 months. These results suggest that the UCV-incidentaloma may be essentially different from the Cushing's adenoma and unlikely to develop Cushing's syndrome.

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenocorticotropic Hormone; Adult; Aged; Aldosterone; Cushing Syndrome; Female; Humans; Hydrocortisone; Male; Middle Aged; Radionuclide Imaging; Regression Analysis

We report a case of preclinical Cushing's syndrome in a 54-year-old male associated with bilateral adrenocortical tumours. Physical findings and general laboratory data were unremarkable except for mild hypertension (158/90 mmHg) and impaired glucose tolerance. Endocrinological evaluation revealed the presence of autonomous cortisol secretion including unsuppressible serum cortisol by 8 mg dexamethasone test (11 microg/dl), high serum DHEA-S (3580 ng/ml, normal: 400-3500) and increased urinary 17-KS excretion (31.0-35.8 mg/day, normal: 5.8-21.3). CT scan demonstrated the presence of tumours in both adrenals and bilateral adrenalectomy was subsequently performed. Histological examination of the resected specimens revealed an adrenocortical carcinoma on the right side and an adenoma on the left side with noticeable cortical atrophy in non-neoplastic adrenals. Immunohistochemical study of steroidogenic enzymes demonstrated that all the steroidogenic enzymes involved in cortisol biosynthesis were expressed in both right and left adrenal tumours. Enzymatic activities of 21, 17alpha, 18, 11beta-hydroxylases were detected in both right and left adrenals except for the absence of 11beta-hydroxylase activity in the left adrenal adenoma. Results of in vitro tissue steroidogenesis examined in short-term tissue culture of the specimens revealed no significant differences between carcinoma and adenoma in cortisol production, but the production of adrenal androgens in carcinoma was significantly higher than that in adenoma, which may indicate the importance of evaluating adrenal androgen levels in patients with adrenocortical neoplasms.

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenalectomy; Carcinoma; Culture Techniques; Cushing Syndrome; Dehydroepiandrosterone Sulfate; Dexamethasone; Glucocorticoids; Humans; Hydrocortisone; Immunohistochemistry; Male; Middle Aged; Neoplasms, Multiple Primary; Steroid Hydroxylases; Tomography, X-Ray Computed

Under analysis are results of an examination of 56 patients with hormonally non-active tumors of the adrenals, 48 of them were operated upon. In 20 patients (35%) they had clinical manifestations, 16 patients (28%) had an elevated level of the 17-HCS and 17-CS excretion in the 24-hours urine. Morphological investigations of the tumors in 20 patients have revealed clear cell adenomas of the cortical layer of the adrenal, in 19 patients--tumoral cysts, in 3 patients--true cysts, in 1 case-myelolipoma, in 1 case--ganglioneuromyelolipoma, in 4 cases--hormonally non-active carcinomas of the adrenal cortex. The authors propose to designate the new formations described as hormonally non-active tumors of the adrenals. In view of the absence of absolute methods for the identification of malignancy of the tumors the operative treatment of them is proposed.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Diseases; Adrenal Cortex Neoplasms; Adrenal Glands; Adult; Aged; Cysts; Humans; Intraoperative Complications; Middle Aged; Tomography, X-Ray Computed; Ultrasonography

A 28-year old female patient with virilization due to left adrenocortical adenoma was studied. The patient had clinical features of hyperandrogenism such as hirsutism and a low pitched voice, but not of hypercorticoidism. Plasma testosterone and dehydroepiandrosterone-sulfate (DHEA-S) were high. Although the basal plasma cortisol concentration and urinary excretion of 17-hydroxycorticosteroids (17-OHCS) were within the normal range, the absence of diurnal variation in plasma cortisol and loss of suppressibility by dexamethasone suggested constitutive secretion of cortisol by the tumor. Inappropriate cortisol secretion was also supported by blunted ACTH response to provocative stimuli. After successful removal of the left adrenal tumor, such endocrinological abnormalities were all normalized. Immunohistochemical analysis revealed that tumor cells were positively stained for C21 hydroxylase cytochrome P-450 (P-450C21) and P-450(11) beta which convert 17-hydroxy (OH) progesterone to cortisol as well as P-450SCC, 3 beta-hydroxysteroid dehydrogenase and P-450(17) alpha which are involved in testosterone biosynthesis. These findings suggest that adrenocortical adenoma secretes predominantly testosterone and constitutively cortisol in a young woman patient with virilization.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adult; Circadian Rhythm; Cortodoxone; Cushing Syndrome; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Female; Humans; Hydrocortisone; Immunohistochemistry; Japan; Testosterone

We present two patients with Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia who showed marked plasma cortisol response to lysine-8-vasopressin (LVP) injection (from 930 and 731 pmol/L to 2177 and 1920 pmol/L, respectively), while plasma ACTH levels remained undetectable. The ACTH independence of cortisol secretion in the two patients was determined from the following endocrinological findings. Plasma cortisol levels were not increased by corticotropin-releasing hormone injections and were not suppressed by high dose (16 mg) dexamethasone administrations. The plasma ACTH levels, measured by two independent sensitive immunoassays, were persistently undetectable even after corticotropin-releasing hormone injection, metyrapone administration, and bilateral adrenalectomy. The particular pathological finding of the two cases, atrophic lesions in nonnodular parts of the adrenal cortexes, also indicated ACTH independence of the macronodular hyperplasia. In vitro examination revealed a direct effect of LVP on cortisol secretion from the adrenal cells of the macronodules. We also examined seven patients with Cushing's syndrome caused by adrenal adenoma and found a statistically significant plasma cortisol response to LVP injection. The direct effect of LVP was also demonstrated in cultured adenoma cells. In conclusion, we discovered a direct adrenal effect of LVP on cortisol secretion in patients with ACTH-independent macronodular hyperplasia and, to a lesser extent, in patients with cortisol-producing adrenal adenoma. The cortisol response to LVP may serve to facilitate their diagnosis and choice of therapy.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Adult; Analysis of Variance; Corticotropin-Releasing Hormone; Cushing Syndrome; Dexamethasone; Female; Humans; Hydrocortisone; Immunoradiometric Assay; Lypressin; Male; Middle Aged; Sensitivity and Specificity

We developed a new method for measuring an unidentified ketosteroid glucuronide (US-G) detected by the method of Iwata et al. for measuring 17-ketosteroid glucuronides by reversed phase HPLC on a Capcell-Pak C8 column with three kinds of mobile phase solutions (Iwata method; Clin Chem 35: 795-799, 1989). The Iwata method inadequately separated US-G and two hydroxy 17-ketosteroides, 11 beta-hydroxyetiocholanolone and 11 beta-hydroxyandrosterone, and it exhibits insufficient sensitivity for measuring traces of US-G in the urine of healthy subjects. We solved these problems by developing a new method which measures US-G in urine, as a free type by hydrolyzing the glucuronide type enzymatically, by normal phase HPLC on a Capcell-Pak Silica column with one kind of mobile phase solution. By this method, the levels of US excreted as a glucuronide in the urine of healthy subjects and of patients with Cushing's syndrome were determined as proportions of the levels of 11 beta-hydroxyandrosterone. The average daily urinary excretion of US was 971 micrograms (125-4,995 micrograms) in patients with Cushing's syndrome (n = 22: two males and 20 females aged 26 to 65 years), and 34 micrograms (0-141 micrograms) in healthy subjects (n = 63: 49 males, and 14 females aged 21 to 54 years), and the differences were clearly significant. However, there were no differences between the urinary US levels of patients with pituitary adenoma and patients with adrenal adenoma. Furthermore, no US was detected in the urine of patients with aldosteronism (two males and eight females aged 34 to 61 years).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: 17-Ketosteroids; Adenoma; Adult; Aged; Chromatography, High Pressure Liquid; Cushing Syndrome; Female; Glucuronates; Humans; Ketosteroids; Male; Middle Aged; Pituitary Neoplasms; Reference Values

Adrenal tumors showing no clinical manifestations (incidentaloma) are frequently encountered during imaging analysis upon routine examinations. These tumors are sometimes associated with hypertension and/or diabetes mellitus (DM). We have examined six cases of incidentalomas with these symptoms in this study. All patients underwent endocrinological evaluation by measuring plasma cortisol and aldosterone levels to assess adrenocortical function. The levels of urinary 17-hydroxysteroids, 17-ketosteroids and catecholamines were also measured. Imaging analysis were performed by using 131I-adosterol scintigraphy, computed tomography and magnetic resonance imaging. Whereas one case was diagnosed as having an adrenal adenoma without the examination of a surgical specimen, other cases underwent surgical removal of the tumor, and final diagnoses were made by pathohistological examination of the tumors. Three cases were diagnosed as having adrenocortical adenomas (one was functioning and others were non-functioning) and one case was diagnosed as having a functional adrenocortical carcinoma. Adenomas were found to produce either non-functional steroids or a small amount of functional steroid hormones. The adenoma patients all suffered hypertension, whereas one of the adenoma patients and the carcinoma patient showed signs of DM. By contrast, of the six cases, one case was diagnosed as having an adrenal cyst, and one case was diagnosed with myelolipoma. Although these two cases suffered DM and hypertension, respectively, it seemed to be unlikely that these clinical symptoms were caused by the adrenal disease. Thus, the present analysis of the six incidentaloma patients suggests that once an adrenal incidentaloma patient with hypertension and/or DM is found, both endocrinological and imaging examinations are necessary to determine the indication of surgical treatment. This analysis supports the present consensus that non-functional adenomas whose sizes are 3cm or less and whose sizes do not change at any reevaluation period, as well as adrenal cysts and myelolipoma should not be surgically removed.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Aged; Aldosterone; Carcinoma; Catecholamines; Cushing Syndrome; Diabetes Mellitus; Female; Humans; Hydrocortisone; Hydroxysteroids; Hypertension; Male; Middle Aged

Hirsutism in women is usually caused by benign adrenal or ovarian disorders, but it can also be caused by adrenal carcinoma. The most effective way to identify such carcinomas is not known.. We measured serum and urinary steroids before and after the administration of 3 mg of dexamethasone per day for five days in 14 hirsute women with histologically proved adrenal tumors (12 adrenal carcinomas and 2 adrenal adenomas) and in 73 women with hirsutism of non-neoplastic origin.. All the women with adrenal tumors had elevated basal serum concentrations of testosterone or dehydroepiandrosterone sulfate, as compared with 36 of the 73 women with non-neoplastic hirsutism (sensitivity, 100 percent; 95 percent confidence interval, 77 to 100; specificity, 50 percent; 95 percent confidence interval, 38 to 62). After the administration of dexamethasone, serum dehydroepiandrosterone sulfate concentrations and urinary 17-ketosteroid excretion decreased to values similar to those in normal women in all the women with non-neoplastic hirsutism, but in none of the 12 with adrenal tumors who were tested. All the women who did not have adrenal tumors had serum cortisol concentrations below 3.3 micrograms per deciliter (90 nmol per liter) after dexamethasone administration, whereas in all 12 patients tested who had tumors the values were higher. The suppression of serum dehydroepiandrosterone sulfate and cortisol and urinary 17-ketosteroid excretion excluded the likelihood of adrenal tumors with a sensitivity of 100 percent (95 percent confidence interval, 74 to 100) and a specificity of 100 percent (95 percent confidence interval, 89 to 100).. Among women with hirsutism, an adrenal tumor is unlikely if the patient has normal basal serum concentrations of testosterone and dehydroepiandrosterone sulfate. In women in whom these concentrations are elevated, a tumor is unlikely if the serum concentration of dehydroepiandrosterone sulfate and urinary 17-ketosteroid excretion are in the normal basal range and the serum cortisol concentration is less than 3.3 micrograms per deciliter after the administration of dexamethasone.

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Androstenedione; Carcinoma; Cushing Syndrome; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Hydrocortisone; Luteinizing Hormone; Middle Aged; Reference Values; Testosterone

A tumour of the left adrenal gland was identified in a woman who presented with virilization and secondary amenorrhea. Preoperatively, the plasma levels of dehydroepiandrosterone sulphate, dehydroepiandrosterone, androstenedione, testosterone, 5 alpha-dihydrotestosterone and 5-androstene-3 beta,17 beta-diol were elevated two- to fourfold whereas those of urinary 17-ketosteroids were elevated more than tenfold. The production rate of dehydroepiandrosterone sulphate was more than 16 times that in normal women whereas those of dehydroepiandrosterone, testosterone and androstenedione were approximately twofold greater; plasma testosterone was derived almost entirely from the peripheral conversion of androstenedione. Blood was obtained by catheterization of the ovarian veins, left adrenal gland vein and inferior vena cava (at two different sites) and plasma steroid levels were determined: testosterone and cortisol levels were elevated in all blood samples whereas those of androstenedione, dehydroepiandrosterone sulphate and 11-desoxycortisol were approximately six- to eightfold, 1.5-fold and nine- to 22-fold higher in the effluent on the left adrenal gland/tumour compared with the levels in the other compartments. Blood was collected hourly for 24 h to determine steroid levels under basal conditions and, also, after ACTH treatment. Plasma cortisol levels increased markedly upon ACTH administration and fell to very low levels 11 h later, but those of androstenedione, testosterone, dehydroepiandrosterone, 5-androstene-3 beta,17 beta-diol and dehydroepiandrosterone sulphate were not affected by ACTH treatment. A histological diagnosis of cortical adenoma of the extirpated tumour was made. Tissue explants and adenoma cells were maintained in culture to characterize the steroid-metabolizing properties of the tumour. The secretion of dehydroepiandrosterone sulphate by tissue explants was highly initially, but declined to almost undetectable levels after 5 days in culture. In the presence of ACTH, dehydroepiandrosterone sulphate secretion remained elevated throughout the entire study up to 5 days. Basal secretion of dehydroepiandrosterone sulphate, androstenedione, 11-desoxycortisol, cortisol, testosterone and 11 beta-hydroxyandrostenedione by adenoma cells was either very low or undetectable. In the presence of ACTH, dibutyryl cyclic AMP or cholera toxin the secretion of dehydroepiandrosterone sulphate, androstenedione and 11-desoxycortisol increased markedly with t

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Amenorrhea; Androgens; Androstane-3,17-diol; Androstenedione; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dihydrotestosterone; Female; Humans; Testosterone; Tumor Cells, Cultured; Virilism

A previously unknown HPLC peak was recently observed in urine samples from patients with Cushing's syndrome and disease. We analysed dansylated derivatives of 17keto steroid glucuronides in urine samples from patients with Cushing's syndrome, Cushing disease and from healthy subjects using high-performance liquid chromatography (HPLC) on reversed-phase Cap Cell PakC8. All urine samples from patients with Cushing's syndrome caused by adrenal adenoma and Cushing's disease showed an unknown large peak at the point between [110HE-G] and [110HA-G] peaks and at a retention time of 25.4 min. The same unknown peak was also observed in urine samples from a patient with asymptomatic cortisol-producing adrenal adenoma and two patients with ectopic ACTH-producing tumor, though the peak height was low for the former and one of the latter but high for the second of the two patients. In contrast, healthy male and female urine only showed a very small peak at the same retention time. Urine samples from a Cushing disease treated with op'DDD and Cushing's syndrome bilaterally adrenalectomized and treating with cortisol showed no such peak. The retention time of this unknown peak is clearly different from that of seven 17keto steroid standard glucuronide conjugates. The structure of this substance may be closely related to [110HE-G] or [110HA-G].

Topics: 17-Ketosteroids; Adenoma; Adenoma, Basophil; Adrenal Gland Neoplasms; Adult; Androstane-3,17-diol; Chromatography, High Pressure Liquid; Cushing Syndrome; Female; Hormones; Humans; Male; Middle Aged; Pituitary Neoplasms

A 40-year-old white woman presented with hirsutism, amenorrhea, generalized fatigue, diffuse weight gain, acral changes, and coarsened facial features. Physical examination revealed mild diastolic hypertension, acromegalic features, hirsutism, and seborrhea. The growth hormone concentration was elevated and did not suppress after glucose administration. Urinary free cortisol excretion was increased and was not suppressed during a 2 mg low-dose dexamethasone suppression test. Magnetic resonance imaging of the sella demonstrated a 1.3 x 1.2 x 0.8 cm pituitary adenoma. Trans-sphenoidal resection was performed, and portions of the resected tumor were analyzed by routine pathologic methods. Histopathologic and immunohistochemical findings indicated discrete growth hormone- and adrenocorticotropic hormone-producing pituitary adenomas. Coexisting acromegaly and Cushing's syndrome due to pituitary neoplasia was previously reported in two patients. However, to the authors' knowledge, this represents the first description of a patient with acromegaly and Cushing's disease resulting from discrete synchronous adenomas of the pituitary gland as defined by modern histopathologic techniques.

Topics: 17-Ketosteroids; Acromegaly; Adenoma; Adult; Cushing Syndrome; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Female; Hirsutism; Humans; Hydrocortisone; Magnetic Resonance Imaging; Pituitary Neoplasms; Reference Values; Testosterone

Evaluation of the clinical and biochemical parameters for differential diagnosis of two types of Cushing's syndrome, pituitary-dependent Cushing's disease and adrenal adenoma, was studied with analysis of the histories of 79 cases of Cushing's disease and 23 cases of adrenal adenoma. The data show that the symptoms, signs and the routine biochemical analyses were not significantly different between two groups. High-dose dexamethasone suppression test had about 90% coincidence rate in the differential diagnosis with 24-hour urine free cortisol (UFC), which was better than 24-hour urine 17-OHCS. Interestingly, low-dose dexamethasone test was highly valuable and the 24-hour urine 17-KS quite helpful in the differential diagnosis of two types of Cushing's syndrome. Serum N-POMC measurement was the most valuable among the parameters, because there was no overlap between the two groups of Cushing's syndrome.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Cushing Syndrome; Dexamethasone; Diagnosis, Differential; Female; Humans; Hydrocortisone; Male; Peptide Fragments; Pro-Opiomelanocortin

A 48-year-old man was admitted for treatment of Cushing's syndrome due to right adrenal adenoma, associated with chronic renal failure (CRF) with a blood urea nitrogen level of 64.2 and serum creatinine level of 3.9 mg/dl. After removal of the adrenal adenoma, the CRF deteriorated with progressive symptoms of anorexia, vomiting and hypertension, and the patient was placed on hemodialysis. Prior to adrenalectomy, the 17 OHCS and 17 KGS in the urine were not so high. However, the urinary 17 KS was high with an elevated 11-oxy fraction. In comparison with 2 patients suffering from adrenal Cushing's syndrome with normal renal function, there were no large accumulated quantities of glucuronic conjugated and unconjugated metabolites in the plasma of the CRF Cushing's syndrome, with confirmation ascribable to the radioimmunoassayable cross-reactivity of the cortisol antiserum used in the radioimmunoassay kit. In the Cushing's syndrome with CRF, almost all the cortisol, which was hypersecreted from the adenoma, was presumed to be converted to the 11-oxy fraction of 17 KS, possibly by activation of hepatic enzymes.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Cushing Syndrome; Female; Humans; Hydrocortisone; Kidney Failure, Chronic; Male; Middle Aged

Virilizing adrenal adenomas are rare, and Leydig cell adenomas of the adrenal rarer still. Our patient, a 60-year-old virilized woman, was found to have a Leydig cell adenoma. Virilization associated with normal 17-ketosteroid and elevated testosterone levels necessitates excluding an adrenal cause. Although one might expect high testosterone levels to suppress gonadotropins, this is not the case. In addition to other studies recommended for assessing the incidentally discovered adrenal mass, we would add a testosterone assay.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Female; Hormones, Ectopic; Humans; Leydig Cells; Male; Middle Aged; Testosterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Diagnosis, Differential; Female; Humans; Middle Aged

The experience with adrenocortical neoplasms in childhood is reviewed. During three decades, ten children with adrenocortical neoplasms were seen at the authors' institution. The literature was reviewed, and 209 patients 16.5 years or younger were found. All ten patients at Vanderbilt University Hospital (VUH) presented with endocrine manifestations of the tumor. Three patients had Cushing's, two patients had virilization, and five patients had features of both. In the literature, virilization, alone or with Cushing's, was the most common mode of presentation. Feminizing tumors were uncommon and nonfunctional tumors rare. The majority of patients were female. Features associated with malignancy included 17-KS levels greater than 40 mg/24 hr, diameter greater than 6 cm, weight greater than 500 g, and histologic evidence of diffuse growth pattern, vascular invasion, and tumor cell necrosis. Although uncommon, adrenocortical neoplasms should be suspected in children with Cushing's, virilization, feminization, or a combination of these. There has been an increased incidence reported in patients with hemihypertrophy, Beckwith-Wiedemann syndrome, hemangiomas, and nevi. Following endocrinologic evaluation, imaging studies should be performed. CT scan appears to be the most useful diagnostic tool. A posterior operative approach is recommended for suspected adenomas. An anterior thoracoabdominal approach is favored for suspected malignancies with uncompromised en bloc resection. There is no evidence that adjuvant therapy provides any additional benefit.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Neoplasms; Carcinoma; Child; Child, Preschool; Cushing Syndrome; Female; Hirsutism; Humans; Hypertrophy; Infant; Male; Prognosis

A 47-year-old woman affected by Cushing's syndrome due to an adrenal adenoma is described. An altered but rhythmometrically apparent cortisol secretory rhythm was detected using the single-cosinor computation. In fact serum cortisol levels and urinary excretion of 17-OHCS were elevated in the PM hours, particularly between 14:00-18.00 h and 18:00-22:00 h, and normal between 02:00-10:00 h. The patient was cured by unilateral adrenalectomy and one year later the circadian rhythm of corticosteroids secretion was investigated again. A normal rhythm of cortisol secretion and of 17-OHCS urinary excretion was found. Though it may be hypothesized that factors intrinsic to the tumoral adrenal cells were responsible for the rhythmic, but phase-shifted, hormonal release, the cause of the persistent and abnormal cortisol secretory rhythm is unknown.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenalectomy; Adrenocorticotropic Hormone; Circadian Rhythm; Cushing Syndrome; Female; Glucocorticoids; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Middle Aged; Pituitary-Adrenal System; Time Factors

Effects of o,p'-DDD on parameters of cortisol metabolism were studied in 3 patients with Cushing's syndrome (ectopic ACTH-syndrome, Cushing's disease, and adrenal cancer). Before o,p'-DDD treatment, plasma cortisol, urinary 17OHCS, and urinary free cortisol were elevated in all patients. These parameters correlated well with each other in ectopic ACTH-syndrome and Cushing's disease. However, in adrenal cancer, urinary 17OHCS did not correlate with either plasma cortisol or urinary free cortisol, while the latter two parameters did. During o,p'-DDD, urinary 17OHCS rapidly declined in a patient with ectopic ACTH syndrome and a patient with Cushing's disease before plasma cortisol or urinary free cortisol decreases. Consequently the positive correlations of urinary 17OHCS with the other parameters were lost. In a case of adrenal cancer, urinary 17OHCS again did not correlate with plasma cortisol or urinary free cortisol. In these conditions, plasma cortisol and urinary free cortisol still significantly correlated. The present results demonstrated the limit of urinary 17OHCS as the index of the cortisol secretion rate both in some cases of adrenal cancer and in patients taking o,p'-DDD. It is suggested that urinary free cortisol should be utilized as a more accurate index for the cortisol secretion rate in such circumstances.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Carcinoid Tumor; Cushing Syndrome; Female; Humans; Hydrocortisone; Male; Middle Aged; Mitotane; Pituitary Neoplasms; Radioimmunoassay; Thymus Neoplasms

Previously in world literature there have been reports of 40 pregnancies in women with untreated Cushing's syndrome. The perinatal mortality in these series has been 12.9%. This paper reports on a case in which low serum oestriol excretion was the first abnormal laboratory value in a patient with only a few signs of Cushing's syndrome habitus and adrenal adenoma.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Cushing Syndrome; Estriol; Female; Humans; Hydrocortisone; Pregnancy; Pregnancy Complications

Seventeen patients with adrenal adenoma causing Cushing's syndrome, eight patients with Cushing's disease due to hypersecretion of ACTH, and five patients with primary aldosteronism due to an aldosteronoma were studied for their computed tomographic (CT) patterns, hormonal profiles, and macroscopic and microscopic findings of the adrenal gland. Black (or brown) adrenal adenomas were found in 71% of the patients with Cushing's syndrome, but not in patients with aldosteronoma. The adrenal tissue of patients with Cushing's disease was predominantly yellow. The number of compact cells was larger in black or brown adenomas than in yellow tumors or hyperplastic adrenal tissue. In patients with Cushing's syndrome, urinary excretion of 17-ketosteroids (17-KS) and serum aldosterone concentrations were lower in those with black or brown adenomas than in those with yellow adenomas (P less than 0.05). Patients with Cushing's disease had even higher 17-KS and serum aldosterone levels. No difference was found in serum cortisol concentrations and dexamethasone suppressibility in two types of adenomas causing Cushing's syndrome. Visual estimation of radiological density of the adrenal tissue relative to the kidney on CT scan and quantitative measurement of it by CT number revealed a difference between the two types of adrenal tumors causing Cushing's syndrome. Adrenal tumors with decreased density on CT scan were yellow adenomas with predominantly clear cells, and those with equal or increased density were black or brown adenomas with predominantly compact cells. All aldosteronomas had decreased density and consisted of clear cells. It is suggested that black or brown adenomas of the adrenal gland have higher radiological density and accompanying lower serum aldosterone and urinary 17-KS levels than ordinary yellow tumors. The abundance of compact cells may have some significance for the development of this particular type of adrenal tumor.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Neoplasms; Adult; Aldosterone; Color; Cushing Syndrome; Female; Humans; Hydrocortisone; Male; Microscopy, Electron; Middle Aged; Tomography, X-Ray Computed

Steroid excretion in urine of 12 infants with virilising adrenal tumours has been determined using gas chromatography. In six children, (Group A, five female, one male) aged 2.8-5.3 years, very high urinary excretions of 17 oxosteroids (greater than 40 mumol/24 h) were largely accounted for by dehydroepiandrosterone (DHA). In one of the girls, the pattern of steroids excreted in urine was similar to that of newborn infants, with high excretions of 16-oxygenated derivatives of DHA. The histology of this tumour suggested a neoplasia of fetal-type adrenocortical cells. Very large tumours were found in three of the infants, two of whom have died and one has multiple metastases. From the other three children, small, well-encapsulated adenomas were successfully removed. Six children (Group B), had moderately elevated 17-oxosteroid excretions (8-17 mumol/24 h). In five of these cases (four female, one male) aged 0.8-5 years, 11 beta-hydroxyandrosterone was a consistently prominent urinary steroid. In one boy, aged 7.7 years, 17-oxosteroid excretion was 15 mumol/24 h and the major steroids in urine were metabolites of pregnenolone. These six children have survived with no clinical evidence of recurrent tumour. The in vivo functional activities of the tumours can be deduced from the different profiles of steroids in urine. These have revealed heterogeneous patterns of steroid biosynthesis.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Androsterone; Carcinoma; Child; Child, Preschool; Chromatography, Gas; Dehydroepiandrosterone; Female; Humans; Infant; Male; Steroids

With the wider application of increasingly sensitive computed tomographic scans, more adrenal masses will be discovered incidentally. Because benign lesions of the adrenal are much commoner than malignant ones, an approach is needed to determine which incidentally discovered masses should be removed. The history and physical examination may guide the evaluation. Imaging studies and needle biopsies have limited value. If the history and physical findings do not suggest a diagnosis, an approach using the size of the mass, results of any cyst puncture, and a biochemical assessment may determine which patients should have surgery. This approach is based on the relative prevalence of benign and malignant clinically silent adrenal tumors.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Biopsy, Needle; Carcinoma; Diagnosis, Differential; Female; Humans; Male; Pheochromocytoma; Sex Factors; Tomography, X-Ray Computed

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Carcinoma; Cushing Syndrome; Female; Humans; Hydrocortisone; Infant; Male; Middle Aged

The presence of an androgen-secreting tumor in a 29-year-old woman was confirmed and its location was determined by computerized axial tomographic (CAT) scanning. The hormone production from this virilizing adrenal adenoma was studied in vivo and in vitro. The major secretory products of the tumor (as compared to normal adrenal tissue) were testosterone (24-fold) and 17 beta-estradiol (five-fold). Although the adenoma produced lesser amounts of dehydroepiandrosterone sulfate (DHEAS), the demonstration of elevated serum testosterone and DHEAS in serial samples was a better marker for an androgen-secreting adrenal tumor than were the urinary 17-ketosteroids, which remained in the upper limit of normal. The hormone production from the tumor depended neither on adrenocorticotropic hormone nor on human chorionic gonadotropin. The conclusions were that: (1) on the basis of serial measurements of serum testosterone and DHEAS, virilizing adrenal adenomas may be suspected when the concentrations of these hormones reach or exceed 200 ng/dl and 6,600 ng/ml, respectively; (2) the high-resolution CAT scanner can accurately localize these tumors; (3) cosmetic and menstrual dysfunction regressed after resection of the tumor; and (4) virilizing adrenal adenomas may produce both androgens and estrogens.

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenal Glands; Adult; Androgens; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; Humans; In Vitro Techniques; Testosterone; Tomography, X-Ray Computed; Virilism

ACTH-stimulation adrenal imaging (ACTH-I) was performed in 14 patients after baseline imaging (B-I) was performed. In six patients with no adrenal diseases in whom the findings of B-I were equivocal, morphologic normality of the adrenals was confirmed by ACTH-I because of increased adrenal uptake of radioiodocholesterol. In three patients with cortisol-producing tumors, visualization of contralateral glands by ACTH-I provided indirect evidence for autonomous cortisol secretion of the tumors. In three patients with pheochromocytoma or cyst, ACTH-I increased adjacent cortical radioactivity to more clearly delineate the lesions. In two patients with primary adrenocortical insufficiency, exogenous ACTH had no effect on adrenal uptake of the tracer. Correlation was observed between response of the adrenal net counts and urinary excretion of 17-OHCS and 17-KS. ACTH-I is useful when B-I does not provide sufficient diagnostic information or further information is needed due to low or absent radioiodocholesterol uptake by the adrenal gland(s).

Topics: 17-Ketosteroids; 19-Iodocholesterol; Addison Disease; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Aged; Cholesterol; Female; Humans; Hypertension; Male; Middle Aged; Pituitary-Adrenal Function Tests; Radionuclide Imaging

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Female; Humans; Middle Aged; Testosterone; Virilism

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adult; Aged; Female; Humans; Hydrocortisone; Male

A rare case of an adrenal adenoma that produced virilization by an isolated secretion of testosterone without a concomitant increase in 17-ketosteroids is reported. It was erroneously concluded that the patient's hypertestosteronemia was due to an ovarian disorder because the urinary 17-ketosteroids were normal. It then was speculated that the adenoma's enzyme system was so efficient it was capable of converting the more prevalent androstenedione directly to testosterone without metabolizing it to 17-ketosteroids. Removal of the adrenal adenoma completely cured the patient's hirsutism.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Female; Hirsutism; Humans; Testosterone

We report the hormonal and radiological evaluation of two cases of adrenal cortical adenomas that secreted testosterone exclusively. We discuss some of the pitfalls in the diagnosis of this lesion, and summarize the current knowledge of the characteristic hormonal features in the two cases and the 12 cases previously reported.

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adult; Dexamethasone; Estradiol; Female; Follicle Stimulating Hormone; Humans; Hydrocortisone; Luteinizing Hormone; Male; Middle Aged; Pregnancy; Testosterone

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Female; Humans; Leydig Cells; Male; Menopause; Middle Aged; Testosterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex; Adrenal Gland Neoplasms; Adrenalectomy; Adult; Child; Cushing Syndrome; Female; Humans; Hydrocortisone; Male; Pituitary Neoplasms; Pregnancy

Pituitary function has been studied sequentially after transsphenoidal removal of pituitary microadenomas in two men with Cushing's disease. Patient 1 gradually regained normal glucocorticoid levels with normal diurnal variation, metyrapone responsiveness, and low dose dexamethasone suppressibility (17-hydroxycorticosteroid, 6.5-0.9 mg/24 h). GH levels rose from 1 to 35 ng/ml during insulin hypoglycemia and from 2.3 to 27 ng/ml during arginine infusion. PRL secretion rose normally in response to thorazine, and gonadotropin and TSH levels remained normal. Patient 2 regained significant metyrapone responsiveness by 9 months postoperatively (11-deoxycortisol rose to 11.7 micrograms/dl), had a normal spontaneous nocturnal rise in PRL secretion, and normal levels of testosterone and thyroid hormones. The return to normal of cortisol-ACTH dynamics and GH responsiveness in Patient 1 and the normal nocturnal surge in PRL secretion in Patient 2 imply that in these patients the etiology of Cushing's disease was not related to hypothalamic dysfunction.

Topics: 17-Ketosteroids; Adenoma; Adult; Cushing Syndrome; Follicle Stimulating Hormone; Humans; Hydrocortisone; Insulin; Luteinizing Hormone; Male; Metyrapone; Pituitary Gland; Pituitary Neoplasms; Thyroxine

A 41-yr-old female with presumed Cushing's syndrome was found to have a diurnal cortisol rhythm characterized by low values of 8:00 a.m. and consistently high values at 4:00 p.m. and midnight. Hourly sampling of plasma cortisol over 24 hr confirmed this rhythm, as did measurement of urinary free cortisols in samples collected every 6 hr over 24 hr. Hypercortisolemia was not suppressed by 2 mg of dexamethasone given every 6 hr for 24 hr. The adrenal tissue was responsive to ACTH. Iodocholesterol scanning revealed unilateral activity, and the patient's syndrome was cured by resection of an adrenal adenoma. In this patient a diurnal cortisol secretory pattern was present due to the secretory activity of the adenoma. The cause of the abnormal but persistent diurnal pattern is unknown.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Circadian Rhythm; Cushing Syndrome; Dexamethasone; Female; Humans; Hydrocortisone

We report on four patients, aged seven months to seven years, with virilizing adrenal cortical tumors. Diagnosis was made by clinical and laboratory data. Tumor localisation was achieved preoperatively in three patients. In two patients both androgen and glucocorticoid excretion were elevated. In three patients histological examination showed a carcinoma, in one patient an adenoma was suggested. There were no metastases. In two patients surgical removal was followed by cytostatic therapy, in one of them additional irradiation treatment was carried out. This child died 10 1/2 years later from a metastasizing renal cell carcinoma which originated from the kidney being situated in the irradiated area.

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Child; Female; Glucocorticoids; Humans; Infant; Male

Two cases of androgen secreting adrenocortical carcinoma have been described by light and electron microscopy. The histological and ultrastructural features of the tumour cells were similar to those of compact cells of zona reticularis and to those described in virilizing adenomas. They possess numerous mitochondria with lamellar and tubular cristae, abundant smooth endoplasmic reticulum, lipofuscin bodies and scanty lipid. Irregularly shaped, crenated mitochondria, with outpouchings of the outer limiting membrane have also been observed. The clusters of neoplastic cells were surrounded by basement membrane which demonstrated a focal discontinuity, probably reflecting malignancy of the tumours. Hyperplasia of smooth endoplasmic reticulum and the presence of outpouchings of the mitochondrial outer limiting membrane might be the morphological manifestation of endocrine activity of the tumours.

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenalectomy; Androgens; Child, Preschool; Female; Humans; Liver Neoplasms; Male; Neoplasm Metastasis

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Androstenedione; Chorionic Gonadotropin; Dehydroepiandrosterone; Dexamethasone; Female; Follicle Stimulating Hormone; Ganglioneuroma; Gonadotropin-Releasing Hormone; Humans; Hydrocortisone; Luteinizing Hormone; Testosterone

A third case of a testosterone-secreting adrenal adenoma is presented. It differs from the other 2 cases in additionally having glucocorticoid abnormalities. Clinically, the patient had been considered as having polycystic ovaries and did show some improvement with estrogen therapy. In fact, were it not for enlarging uterine leiomyomata on this therapy which prompted a more in depth investigation to look for alternative therapy, this potentially malignant adrenal lesion may never have been discovered.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Dexamethasone; Diagnosis, Differential; Female; Humans; Hydrocortisone; Polycystic Ovary Syndrome; Testosterone

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Aged; Female; Humans; Virilism

A 2 1/2 year old girl with virilization and advanced bone age was found to have a leftsided adrenocortical adenoma. The secretion of mainly androgens besides estrogens was not suppressible with dexamethasone. Plasma cortisol levels were not elevated but did not show any circadian rhythm. The tumor was localized by retroperitoneal instillation of gas, intravenous urography and tomography. After complete removal of the tumor the originally strongly elevated excretion of 17-ketosteroids sank back to normal, the acceleration of skeletal development slowed down. The right adrenal cortex was not atrophic, 2 1/2 years after the operation the child is well and without evidence of recurrent disease. Differential diagnosis as well as ultrastructor and histology of the tumor are discussed with reference to the literature.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Bone Development; Child, Preschool; Diagnosis, Differential; Female; Humans; Hydrocortisone

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Child; Child, Preschool; Dexamethasone; Growth Disorders; Humans; Hydrocortisone; Male; Metyrapone; Puberty, Precocious

The presenting signs, symptoms, roentgenographic findings, endocrine evaluations, treatment, and results in 68 cases of presumed pituitary adenomas treated over an 18-year period are discussed. The most common symptoms were headache, acromegalic changes, visual symptoms, and amenorrhea. Most common physical findings were obesity, acromegaly, and visual field defects, usually bitemporal hemianopsia. Roentgenographic evidence of sellar erosion was almost universal but angiography and pneumoencephalography were required to evaluate suprasellar extension. Brain scan was not considered a particularly useful diagnostic tool. Endocrine status was best evaluated by a battery of tests including 17-OH, 17-KS, T3, T4, PBI, ACTH stimulation, and FSH and STH levels. (Prolactin levels are currently being obtained, also). Surgical specimens were obtained in 29 patients, with subsequent diagnoses of 22 chromophobe adenomas, five eosinophilie adenomas, one cystic adenoma, and one necrotic tumor. All five eosinophilic tumors came from acromegalic patients. Patients treated by operation alone or operation followed by radiotherapy generally had less "medical morbidity" than did patients who received radiotherapy alone.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Acromegaly; Adenoma; Adenoma, Acidophil; Adenoma, Chromophobe; Adolescent; Adult; Aged; Amenorrhea; Carotid Arteries; Female; Follow-Up Studies; Humans; Hypophysectomy; Male; Middle Aged; Neoplasm Recurrence, Local; Optic Atrophy; Pituitary Irradiation; Pituitary Neoplasms; Pneumoencephalography

Feminizing adrenal tumors in young boys are rare; such patients initially show bilateral gynecomastia, and may have signs of virilization. We present a patient with bilateral gynecomastia, left adrenal adenoma, and elevated estrogen levels but normal levels of 17-ketosteroids.

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Child, Preschool; Estrogens; Gynecomastia; Humans; Male

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Adult; Female; Humans; Saliva; Sex Chromatin

Thirty-four cases of corticosurrenaloma with clinical onset before 15 years of age have been studied. Higher frequency in girls (65 percent of the cases) and in young age (80 percent before 5 years of age, 43 percent before 2 years), association with personal or familial other tumors and malformations, are noticeable features. Virilism is the major manifestation in children (83 percent of the cases), either isolated or associated with hypercortisolism and/or feminization. Hormonal assays are of little value, and the dynamic adrenal tests are of some help only in small tumors or isolated hypercortisolism. Radiological diagnosis by urography with cavography, arteriography, is easy in most cases. Evaluation of prognosis is very difficult. Clinical and biological data are not significant, histological data are often of little help. Only a very large mass, and occurrence of metastases (liver, lungs) evidence malignancy. This series does not allow to assess definitely the best therapeutic regimen. Surgery has to be performed as soon as possible. The effects of radiations have not yet been ascertained. High doses of op'DDD have led to a sustained remission of the tumor or metastases in 2 patients, and perhaps to a longer survival in 4 others.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Angiography; Child; Child, Preschool; Cushing Syndrome; Dehydroepiandrosterone; Female; Feminization; Humans; Male; Mitotane; Urography; Virilism

A virilizing adrenocortical adenoma was demonstrated in a yound female. Urinary 17-ketosteroid excretion and subfractions, plasma testosterone level and urinary 17-ketogenic steroid excretion were markedly increased. Dehydroepiandrosterone was the main constituent of the androgen excess. Otherwise the adrenocortical function was found to be normal as evaluated from measurements of cortisol, corticosterone and their metabolites under basal conditions and during dynamic tests. The androgen excess showed an unexpected response to trophic hormones. Human chorionic gonadotrophin stimulation resulted in a pronounced increase in androgen production, whereas no gonadotrophin-dependency could be demonstrated by means of the oestrogen suppression test. Similarly, no corticotrophin-dependency could be demonstrated by corticotrophin stimulation and suppression tests. Removal of the tumour resulted in normalization of the androgen production and no abnormal response upon human chorionic gonadotrophin administration could now be found. The inappropriate response of tumours to trophic hormones is discussed. It is concluded that the reliability of stimulation and suppression tests in determining the site of excessive androgen production should be accepted with reservation.

Topics: 11-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Androgens; Androsterone; Chorionic Gonadotropin; Corticosterone; Dehydroepiandrosterone; Dexamethasone; Etiocholanolone; Female; Humans; Hydrocortisone; Hydroxycorticosteroids; Ovary; Pregnancy; Stimulation, Chemical; Testosterone

On account of the increasing number of patients with essential obesity the delimitation of the Cushing-syndrome is of actual importance. Two observations of hypercortisolism in hyperplasia of the adrenal glands are reported on and the differential-diagnostically important parameters are demonstrated. According to our opinion anamnesis and clinical findings give the possibility of making a diagnosis already on a large scale. Analyses of the hormones and special X-ray examinations only serve for the preoperative ascertainment and localisation of the endocrine defective function. With the help of literary data causes and possibilities of treatment of Cushing's syndrome are entered.

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Adult; Cushing Syndrome; Diagnosis, Differential; Diet, Reducing; Female; Humans; Hydrocortisone; Male; Obesity

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adult; Androstenedione; Androsterone; Carcinoma; Chromatography, Ion Exchange; Cushing Syndrome; Dehydroepiandrosterone; Etiocholanolone; Female; Humans; Hyperplasia; Male; Middle Aged; Sex Factors; Tetrahydrocortisol

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Androstenedione; Castration; Chorionic Gonadotropin; Dexamethasone; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Middle Aged; Ovary; Testosterone

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Androgens; Endoplasmic Reticulum; Female; Humans; Inclusion Bodies; Microscopy; Microscopy, Electron

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Adrenocorticotropic Hormone; Adult; Blood Pressure; Cortisone; Cushing Syndrome; Dexamethasone; Female; Humans; Hyperaldosteronism; Pigmentation Disorders

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Dyslipidemias; Female; Hirsutism; Hormones, Ectopic; Humans; Middle Aged

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Acetates; Adenoma; Adrenal Gland Neoplasms; Androstenedione; Carbon Isotopes; Carcinoma; Cholesterol; Chromatography, Paper; Chromatography, Thin Layer; Dehydroepiandrosterone; Estradiol; Estriol; Estrogens; Estrone; Female; Humans; In Vitro Techniques; Methods; Middle Aged; Tritium

Topics: 17-Ketosteroids; Acanthosis Nigricans; Adenoma; Adrenal Glands; Adrenalectomy; Adult; Blood Glucose; Estrogens; Female; Glucose Tolerance Test; Humans; Microscopy, Electron

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Child, Preschool; Female; Humans

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Amenorrhea; Aortography; Depression, Chemical; Dexamethasone; Female; Hirsutism; Humans; Pregnanetriol; Radiography, Abdominal; Stimulation, Chemical; Testosterone

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Blood Glucose; Estrogens; Female; Humans; Pregnanediol; Pregnanetriol

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenocarcinoma; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adult; Amenorrhea; Child, Preschool; Cushing Syndrome; Female; Hirsutism; Humans; Infertility, Female; Polycystic Ovary Syndrome; Virilism

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Castration; Chorionic Gonadotropin; Depression, Chemical; Estrogens; Female; Hormones, Ectopic; Humans; Middle Aged; Ovary; Paraneoplastic Endocrine Syndromes; Stimulation, Chemical; Testosterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adult; Androsterone; Chromatography; Diagnosis, Differential; Estrogens; Etiocholanolone; Female; Gonadotropins; Humans; Middle Aged; Neoplasms, Gonadal Tissue; Ovarian Neoplasms; Polycystic Ovary Syndrome; Sertoli-Leydig Cell Tumor

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Hormones; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenalectomy; Adrenocortical Hyperfunction; Adult; Cushing Syndrome; Dexamethasone; Female; Glucocorticoids; Humans; Hyperplasia; Middle Aged; Pituitary Irradiation; Postoperative Care; Postoperative Complications; Radiography

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Carbon Isotopes; Culture Techniques; Cushing Syndrome; Humans; Infant; Testosterone; Tritium

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenocarcinoma; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenalectomy; Affective Symptoms; Age Factors; Aged; Cushing Syndrome; Depression; Female; Humans; Mental Disorders; Middle Aged; Potassium

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Insufficiency; Adrenalectomy; Adrenocortical Hyperfunction; Adult; Alkaline Phosphatase; Cushing Syndrome; Female; Humans; Hyperostosis Frontalis Interna; Hypothalamic Diseases; Hypothyroidism; Leukocytes; Male; Middle Aged; Neutrophils; Obesity; Osteoporosis

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adrenal Insufficiency; Adult; Aged; Alcohols; Amenorrhea; Androsterone; Carcinoma; Child, Preschool; Chromatography, Gas; Cushing Syndrome; Dehydroepiandrosterone; Etiocholanolone; Female; Genital Diseases, Male; Hirsutism; Humans; Hyperplasia; Hyperthyroidism; Hypospadias; Infant; Infertility, Male; Klinefelter Syndrome; Lactation Disorders; Male; Middle Aged; Polycystic Ovary Syndrome; Pregnancy; Pregnanetriol

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Humans; Hyperaldosteronism; Hypertension; Potassium

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Aged; Child; Child, Preschool; Cushing Syndrome; Dexamethasone; Female; Humans; Hydrocortisone; Infant; Male; Middle Aged; Pituitary-Adrenal Function Tests; Radiography

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Acromegaly; Adenoma; Cardiac Catheterization; Cerebral Ventriculography; Electrocardiography; Follicle Stimulating Hormone; Heart Failure; Humans; Male; Middle Aged; Pituitary Neoplasms; Thyroid Function Tests

Topics: 17-Ketosteroids; Acne Vulgaris; Adenoma; Adrenal Gland Neoplasms; Adrenalectomy; Child, Preschool; Cortisone; Female; Humans; Virilism

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Cushing Syndrome; Dexamethasone; Diagnosis, Differential; Female; Gonadotropins, Pituitary; Humans; Menstruation Disturbances; Norethynodrel; Ovarian Neoplasms; Ovary; Pituitary-Adrenal Function Tests; Polycystic Ovary Syndrome

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenalectomy; Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Dexamethasone; Female; Glucocorticoids; Humans; Male; Middle Aged; Pituitary Neoplasms

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adult; Amenorrhea; Autopsy; Chlorides; Diagnosis, Differential; Duodenum; Female; Gastric Juice; Humans; Intestines; Jejunum; Pancreas; Parathyroid Neoplasms; Peritonitis; Pituitary Diseases; Potassium; Radiography; Sodium; Stomach; Vaginal Smears; Zollinger-Ellison Syndrome

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Cushing Syndrome; Female; Humans; Infant; Male; Obesity; Postoperative Care; Preoperative Care; Urography

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adult; Androgens; Androstanes; Clitoris; Dehydroepiandrosterone; Female; Humans; Hypertrophy; Testosterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Androstanes; Carbon Isotopes; Child; Chromatography; Dehydroepiandrosterone; Humans; Hydroxysteroid Dehydrogenases; In Vitro Techniques; Isomerases; Male; Spectrophotometry; Sterols; Ultraviolet Rays; Virilism

Topics: 17-alpha-Hydroxypregnenolone; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenal Glands; Androgens; Breast Neoplasms; Carbon Isotopes; Dehydroepiandrosterone; Estrogens; Female; Humans; Hydrocortisone; In Vitro Techniques; Pregnenolone; Testosterone; Transferases; Tritium

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Aged; Aldosterone; Angiotensin II; Animals; Biological Assay; Diagnosis, Differential; Female; Furosemide; Humans; Hyperaldosteronism; Hypertension; Hypokalemia; Male; Middle Aged; Posture; Potassium; Rats; Renin; Saliva; Sodium; Water-Electrolyte Balance

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Aldosterone; Blood Pressure; Catecholamines; Chlorothiazide; Creatinine; Diagnosis, Differential; Diet; Epinephrine; Humans; Hyperaldosteronism; Hypertension; Hypertension, Renal; Hypokalemia; Infusions, Parenteral; Norepinephrine; Potassium; Renal Artery Obstruction; Renin; Sodium; Vanilmandelic Acid

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenalectomy; Adult; Bronchial Neoplasms; Carcinoid Tumor; Cushing Syndrome; Female; Glucocorticoids; Humans; Hydrocortisone; Hydroxyindoleacetic Acid; Rib Fractures; Serotonin

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Abnormalities, Multiple; Adenoma; Adrenal Gland Neoplasms; Carcinoma; Child, Preschool; Cushing Syndrome; Dexamethasone; Female; Growth; Humans; Hydrocortisone; Hypertrophy; Infant; Infant, Newborn; Insulin; Male; Metyrapone; Pituitary-Adrenal Function Tests; Radiography; Sepsis

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Acne Vulgaris; Adenoma; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Carcinoma; Child; Child, Preschool; Dehydroepiandrosterone; Female; Hirsutism; Humans; Infant; Lung Neoplasms; Male; Neoplasm Metastasis; Radiography; Virilism

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adrenocortical Hyperfunction; Adult; Androsterone; Chemistry, Clinical; Chromatography, Paper; Dehydroepiandrosterone; Diagnosis, Differential; Etiocholanolone; Hirsutism; Humans; Hydrocortisone; Hydroxysteroid Dehydrogenases; Hyperplasia; Metabolism, Inborn Errors; Middle Aged

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Androgens; Androsterone; Child; Dehydroepiandrosterone; Humans; Hydroxysteroid Dehydrogenases; Male; Pregnenolone; Steroids; Testosterone

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Dexamethasone; Female; Humans; Hydrocortisone; Virilism

Topics: 17-Ketosteroids; Adenocarcinoma; Adenoma; Adrenal Gland Neoplasms; Cushing Syndrome; Female; Humans

Topics: 17-Ketosteroids; Adenoma; Adult; Estrogens; Female; Gonadotropins; Humans; Hypophysectomy; Neoplasm Recurrence, Local; Pituitary Neoplasms; Pregnancy; Pregnancy Complications

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Adult; Aminoglutethimide; Animals; Anticoagulants; Carcinoma; Cushing Syndrome; Female; Humans; Hydrocortisone; Metyrapone; Middle Aged; Pituitary-Adrenal Function Tests; Secretory Rate

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenocorticotropic Hormone; Adult; Basal Metabolism; Female; Humans; Hypopituitarism; Male; Metyrapone; Pituitary Function Tests; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Postoperative Complications; Radiography

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adult; Androgens; Androsterone; Child, Preschool; Chromatography, Paper; Dehydroepiandrosterone; Female; Glucuronates; Humans; Infant; Male; Pregnanediol; Secretory Rate; Sulfates; Testosterone

Topics: 17-alpha-Hydroxypregnenolone; 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adolescent; Adrenal Glands; Adrenocorticotropic Hormone; Androgens; Carbon Isotopes; Chromatography; Culture Techniques; Dehydroepiandrosterone; Estradiol; Estriol; Estrone; Female; Humans; Hydrocortisone; Hydroxyprogesterones; Pregnenolone; Progesterone; Testosterone

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Adult; Child; Chromatography, Paper; Dehydroepiandrosterone; Dexamethasone; Female; Hirsutism; Humans; Hydroxysteroid Dehydrogenases; Mesenchymoma; Metabolism, Inborn Errors; Puberty, Precocious; Secretory Rate

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Aged; Androgens; Endoplasmic Reticulum; Female; Glycogen; Humans; Microscopy, Electron; Mitochondria

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenal Insufficiency; Adrenalectomy; Adrenocorticotropic Hormone; Adult; Aldosterone; Cushing Syndrome; Female; Humans; Middle Aged; Postoperative Complications

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adrenalectomy; Adrenocortical Hyperfunction; Adult; Carcinoma; Child; Child, Preschool; Cushing Syndrome; Female; Humans; Hyperaldosteronism; Hypertension; Intestinal Polyps; Male; Pheochromocytoma

Topics: 17-Ketosteroids; Adenoma; Adolescent; Adult; Female; Humans; Menstruation Disturbances; Middle Aged; Ovarian Neoplasms; Pregnanediol

Topics: 17-Ketosteroids; Acromegaly; Addison Disease; Adenoma; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Blood; Child; Chromatography, Gas; Cushing Syndrome; Female; Glucuronates; Hirsutism; Humans; Hypogonadism; Klinefelter Syndrome; Male; Middle Aged; Polycystic Ovary Syndrome; Testosterone; Urine

Topics: 17-Ketosteroids; Adenoma; Adenoma, Acidophil; Adenoma, Basophil; Adolescent; Adrenal Cortex Hormones; Adrenalectomy; Adrenocorticotropic Hormone; Aldosterone; Blood Chemical Analysis; Choristoma; Cushing Syndrome; Follicle Stimulating Hormone; Humans; Hydrocortisone; Hypophysectomy; Iodine Isotopes; Myxedema; Neoplasms; Pathology; Pituitary Neoplasms; Radiography; Radioisotopes; Radionuclide Imaging; Thyroid Function Tests; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Carcinoma; Estradiol; Estradiol Congeners; Estriol; Estrone; Geriatrics; Humans; Male; Prostatic Neoplasms; Stilbenes; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Cushing Syndrome; Female; Fetal Death; Humans; Infant, Newborn; Pituitary-Adrenal Function Tests; Pregnancy; Pregnancy Complications; Surgical Procedures, Operative; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Adrenocortical Adenoma; Child; Humans; Hyperaldosteronism; Hypernatremia; Hypertension; Hypertrichosis; Hypokalemia; Potassium; Sodium; Spironolactone; Urine

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adrenalectomy; Adrenocorticotropic Hormone; Alkalosis; Bartter Syndrome; Bronchial Neoplasms; Cushing Syndrome; Dexamethasone; Heart Arrest; Humans; Hypokalemia; Metyrapone; Neoplasms; Neoplasms, Multiple Primary; Pathology; Radiography, Thoracic; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Neoplasms; Adrenal Glands; Aldosterone; Angiography; Blood; Catheterization; Chlorides; Contrast Media; Humans; Hydrocortisone; Hyperaldosteronism; Kidney Function Tests; Phlebography; Potassium; Spironolactone; Surgical Procedures, Operative; Veins

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Androgens; Blood Chemical Analysis; Chromatography; Female; Humans; In Vitro Techniques; Metabolism; Ovarian Neoplasms; Pathology; Surgical Procedures, Operative; Testosterone; Urine; Virilism

Topics: 17-Ketosteroids; Adenoma; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Adrenogenital Syndrome; Cholesterol; Chromatography; Dehydroepiandrosterone; Dexamethasone; Drug Therapy; Gonadotropins; Humans; Hydrocortisone; Lipids; Male; Pathology; Puberty; Puberty, Precocious; Sexual Maturation; Surgical Procedures, Operative; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Cortex Hormones; Adrenal Gland Neoplasms; Aged; Amenorrhea; Atrophy; Breast Diseases; Estrogens; Female; Gonadotropins; Humans; Surgical Procedures, Operative; Urine; Urography

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adenoma; Adenoma, Acidophil; Carbon Isotopes; Child; Endocrine Gland Neoplasms; Humans; Hydrocortisone; Hydroxyindoleacetic Acid; In Vitro Techniques; Male; Metabolism; Surgical Procedures, Operative; Testicular Neoplasms; Urine

Topics: 17-Ketosteroids; 46, XX Disorders of Sex Development; Adenoma; Adrenal Cortex; Adrenal Cortex Hormones; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Adrenogenital Syndrome

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Androgens; Chromatography; Corticosterone; Female; Humans; Hydrocortisone; Hydroxyprogesterones; In Vitro Techniques; Mixed Function Oxygenases; Neoplasms; Progesterone; Virilism

Topics: 17-Ketosteroids; Adenoma; Adenoma, Chromophobe; Adolescent; Adrenal Cortex Hormones; Adrenal Hyperplasia, Congenital; Adrenalectomy; Adrenocorticotropic Hormone; Adrenogenital Syndrome; Blood Chemical Analysis; Cushing Syndrome; Dexamethasone; Humans; Male; Progesterone; Testicular Neoplasms; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenocorticotropic Hormone; Ammonium Chloride; Fallopian Tube Neoplasms; Female; Humans; Pelvic Inflammatory Disease; Prednisone; Urine

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenal Gland Neoplasms; Child; Cortisone; Desoxycorticosterone; Hydrocortisone; Neoplasms; Surgical Procedures, Operative

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Adrenal Hyperplasia, Congenital; Adrenocortical Hyperfunction; Adrenocorticotropic Hormone; Adrenogenital Syndrome; Aldosterone; Cholesterol; Cushing Syndrome; Follicle Stimulating Hormone; Humans; Metabolism; Pituitary-Adrenal Function Tests; Pregnanediol

Topics: 17-Ketosteroids; Adenoma; Androgens; Erectile Dysfunction; Estrogens; Goiter; Graves Disease; Gynecomastia; Humans; Hyperthyroidism; Iodine Isotopes; Male; Mastectomy; Pathology; Thyroid Neoplasms; Thyroidectomy

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex Hormones; Cushing Syndrome; Humans; Hyperplasia

Topics: 17-Ketosteroids; Adenoma; Adrenal Cortex; Adrenal Cortex Neoplasms; Adrenocortical Adenoma; Estrogens; Female; Humans; Virilism

Topics: 17-Ketosteroids; Acromegaly; Adenoma; Chromatography; Growth Hormone-Secreting Pituitary Adenoma; Humans; Neoplasms; Pituitary Gland; Pituitary Neoplasms; Radiotherapy; Steroids