cortodoxone and Adrenal-Gland-Diseases

Topics: Addison Disease; Adrenal Gland Diseases; Adrenocorticotropic Hormone; Biomarkers; Chromatography, Paper; Colorimetry; Cortodoxone; Cushing Syndrome; Dexamethasone; Gas Chromatography-Mass Spectrometry; Humans; Metyrapone; Radioimmunoassay; Reference Values; Specimen Handling; Thyroid Diseases

We describe a method for the determination of urinary free cortisol and glucocorticoids in plasma, used in the diagnosis of adrenal disorders, based on automated reverse-phase high-performance liquid chromatography (HPLC). The within-day and day-to-day CVs were less than 5.5 and 8.0%, respectively. The calibration curves for cortisol and 11-deoxycortisol were linear up to 2000 nmol/L. Cortisol concentrations as low as 3.5 nmol/L in 1 mL of plasma or urine can be measured. Correlation of HPLC results for 40 plasma specimens with those by radioimmunoassay showed r = 0.965. This method is sensitive and free from the interference habitually encountered in immunoassays, and can thus be proposed for research and as a potential reference method.

Topics: Adolescent; Adrenal Gland Diseases; Binding, Competitive; Child; Child, Preschool; Chromatography, High Pressure Liquid; Cortodoxone; Female; Humans; Hydrocortisone; Infant; Male; Radioimmunoassay; Sensitivity and Specificity

The HPLC system was used to separate and measure 10 kinds of corticoids in adrenal tissues. Calibration curves were drawn as straight lines that ranged from 1.25 to 20ng, or 1.25 to 200ng by peak area calculated with the chromatointegrator. The samples for the assay were extracted from homogenized tissues and treated with methanol to remove non-steroidal contaminants which may interfere with the ultraviolet absorption monitor. The recovery rate during the assay procedure was calculated using testosterone as the internal standard, because testosterone was not detected in any adrenal tissue examined in the present study. Contents of corticoids were measured in normal adrenal glands obtained during radical nephrectomy for renal cancer and in functioning adrenal adenomas. Steroid levels in the adrenal glands and tumors have been measured by radioimmunoassay until now, and the data obtained in the present study were compared with those in previous reports. Main steroids in normal adrenals were cortisol (F) and corticosterone (B), and there were certain amounts of 11-deoxycortisol (S), 11-deoxycorticosterone (DOC) and precursor steroids. 11 beta-hydroxy-androstenedione was the main androgen in the adrenal gland. Mineralocorticoids other than B and DOC were very low in the normal adrenals. There was a certain balance between the production of cortisol and corticosterone in normal adrenals. In functioning adenomas, the levels of F, B and aldosterone, and F to B ratios (F/B) varied according to their biological features. Although with the HPLC system it was possible to obtain the production balance of each steroid clearly in the chromatogram, we could not detect the delta 5-3 hydroxysteroids such as pregnenolone and dehydroepiandrosterone using the ultraviolet absorption monitor.

Topics: Adrenal Cortex Hormones; Adrenal Gland Diseases; Adrenal Glands; Adult; Aged; Androstenedione; Chromatography, High Pressure Liquid; Corticosterone; Cortodoxone; Desoxycorticosterone; Female; Humans; Hydrocortisone; Male; Middle Aged

Unstimulated plasma ACTH concentrations remain at or below the detection limit of conventional immunoassays. Grossly elevated ACTH concentrations are diagnostic in suspected adrenal insufficiency, remain elevated well above 200 ng/l during substitution therapy and obviate the need of further tests. For the diagnosis of secondary adrenal failure, plasma ACTH, cortisol and 11-desoxycortisol response to a single midnight dose of metyrapone (1.2 g/m2 = 30 mg/kg) discriminates between a normal (morning ACTH above 100 ng/l), diminished (morning ACTH detectable, but below 100 ng/l), and an absent (ACTH below 20 - 40 ng/l) ACTH reserve. In congenital adrenal hyperplasia, plasma ACTH concentrations mirror, together with 17-alpha-hydroxyprogesterone, the extent of ACTH suppression. Elevated ACTH concentrations were suppressed by prednisolone (25%), dexamethasone (2% of the hydrocortisone dose) or by addition of cyproterone acetate (100 mg/m2/day). Using selective venous catheterisation in clinically and biochemically proven Cushing's syndromes, a pituitary adenoma could be identified and localized in 6 of 8 patients by measuring ACTH concentrations in the left and right petrosal sinus before and after stimulation with corticotrophin releasing hormone.

Topics: 17-alpha-Hydroxyprogesterone; Adenoma; Adrenal Gland Diseases; Adrenal Hyperplasia, Congenital; Adrenal Insufficiency; Adrenocorticotropic Hormone; Adult; Child; Cortodoxone; Cushing Syndrome; Humans; Hydrocortisone; Hydroxyprogesterones; Metyrapone; Pituitary Neoplasms

In normal subjects, plasma pregnenolone sulfate (PS) levels high at birth, decreased during the first year of life in relation to the pattern of involution of the fetal adrenal zone. Thereafter, PS levels, in contrast with those of DHAS, did not show the abrupt rise characteristic of the adrenarche, but increased very progressively till adulthood. The response of PS to various provocative tests of adrenal and pituitary function (ACTH and Metyrapone stimulation, dexamethasone suppression), has been established in normal subjects. The measurement of plasma PS levels in basal conditions as well as in response to dynamic tests was very useful in the diagnosis of various adrenal and pituitary diseases in children.

Topics: Adolescent; Adrenal Gland Diseases; Adrenal Insufficiency; Adrenocorticotropic Hormone; Aging; Child; Child, Preschool; Cortodoxone; Dexamethasone; Female; Humans; Hydrocortisone; Infant; Metyrapone; Pituitary Diseases; Pregnenolone

In this paper the clinical and laboratory-chemical methods of a metopiron short test at midnight are described. In addition to this the results after a conceptional metopiron longtime test and a metopiron short test are compared in 40 endocrinologically healthy persons. It was shown that, compared with the long-term test, in the metopiron short test at midnight no reduction of the informations and of the exactness of the results appears. Since the isolated determination of the increase of substance S after metopiron reveals a relatively broad area of distribution in literature the interpretation normal-pathological is problematic. Therefore it is tried to obtain an improved evidence in the test with the help of an interpretation quotient Q which establishes the variables measured in the regulating circle of the adrenocortico-pituitary system (decrease of the 11-hydrocorticosteroid and increase of the 11-desoxycorticosol in the plasma after application of metopiron, r = 0,96 shown a very good correlation of these two sizes). After utilization of the method of interpretation in persons with different diseases of endocrinological and nonendocrinological etiology the results were in every case good classifications into the areas normal, with limiting value and phathological. The classification of the individual clinical pictures with the help of the interpretation mode mentioned is discussed. Finally the advantages and disadvantages of the used method are compiled.

Topics: 11-Hydroxycorticosteroids; 17-Hydroxycorticosteroids; Adrenal Gland Diseases; Cortodoxone; Humans; Hypothalamo-Hypophyseal System; Metyrapone; Pituitary Diseases; Time Factors