17-ketosteroids and Thymus-Neoplasms

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

A patient with a thymic carcinoid tumour causing ectopic ACTH syndrome is presented. The case illustrates the rapid development of the clinical and laboratory findings often associated with ectopic secretion of ACTH, including severe proximal myopathy, emotional lability, and hypokalaemic alkalosis. Interpretation of conventional tests of pituitary-adrenal function was complicated by intermittent secretion of ACTH by the tumour. The results of selective venous sampling for ACTH ruled out pituitary ACTH hypersecretion and were suggestive of a thymic source; computerized tomography of the chest localized the tumour. In vivo and in vitro investigations confirmed excessive ACTH production by the tumour, and surgical resection plus radiotherapy has resulted in resolution of the syndrome. The diagnostic problems created by intermittent secretion of ACTH by these tumours and the pre-operative and post-operative medical management of these patients are discussed.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenocorticotropic Hormone; Adult; Carcinoid Tumor; Female; Hormones, Ectopic; Humans; Hydrocortisone; Syndrome; Thymus Gland; Thymus Neoplasms; Tomography, X-Ray Computed

Topics: 17-Ketosteroids; Animals; Estrogens; Estrus; Female; Leukemia, Experimental; Mammary Neoplasms, Experimental; Muscles; Neoplasms, Experimental; Ovarian Neoplasms; Ovary; Pregnancy; Rats; Tail; Thymus Neoplasms; Transplantation, Autologous

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adrenocorticotropic Hormone; Cushing Syndrome; Female; Humans; Middle Aged; Neoplasm Metastasis; Radiography, Thoracic; Skull; Thymus Neoplasms

Topics: 17-Ketosteroids; Adolescent; Adult; Age Factors; Aged; Carcinoma, Squamous Cell; Child; Female; Hodgkin Disease; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Neoplasm Metastasis; Prognosis; Radiography; Sex Factors; Thymoma; Thymus Neoplasms