尿17-ketogenic steroid分画の臨床的研究

第2編 健康人並びに各種内分泌疾患におけるACTH試験について

抄録

ACTH-Z 20 units, was administered intramuscularly for 3 successive days in ACTH test. In normal adults, the values of 17-KGS and its two fractions on the 3rd day of injection were as follows : urinary 17-KGS : 40.2±12.6 mg/day, 11-deoxy 17-KGS : 7.3±3.7 mg/day and 11-oxy 17-KGS : 32.8±11.1 mg/day. These valeus were 6.3±2.0, 9.1±2.6 and 5.6±2.0 times as much as those before the injection, respectively. However, no change was observed in 11-deoxy/11-oxy. In elderly subjects, a slight elevation of 11-deoxy/11-oxy due to relative increase of 11-deoxy 17-KGS was observed, suggesting lowered relative efficiency of cortisol synthesis in adrenal cortex.
Three cases of adrenogenital syndrome due to the incomplete block of 21-hydroxylation showed an excessive reaction in the ACTH-Z test. This is mainly due to the remarkable increase of 11-deoxy 17-KGS. The metabolic disturbance, which was observed in the above-mentioned cases, could not to be corrected by the administration of ACTH. In 7 cases with Cushing's syndrome, there was not observed any difference in the reaction to the ACTH-Z administration between the cases with adrenal adenoma and those with adrenal hyperplasia. However, in case with adrenal hyperplasia which did not show any significant reaction in ACTH-Z test, an excessive reaction was observed to the ACTH intravenously infused. This fact indicates the inadequacy of ACTH-Z test for the differentiation of Cushing's syndrome due to the adrenal hyperplasia from those due to the adrenal adenoma. The decreased or delayed reaction in the ACTH-Z test was observed in cases with acromegaly, Addison's disease or panhypopituitarism, wutithout showing any increase of 11-deoxy 17-KGS in most of them.