Various kinds of investigations including the responce test to ACTH and the suppression test by corticosteroid are necessary to evaluate the adrenocortical function.
It is known that there is a diurnal variation of the adrenocortical secretion in human subjects. This diurnal variation is closely related to the regulation of the central nervous system.
The process of adrenocortical suppression by corticosteroid, the adrenocortical diurnal variation, and the influence of corticosteroid on this variation were studied. From these points of view, the author would like to emphasize the following 3 points :
(1) What is the difference of diurnal variations of urinary steroids between normal subjects and patients with endocrine disorders ?
(2) Are the diurnal variation patterns of urinary steroids reproducible ?
(3) How do corticosteroid administrations influence on diurnal variation patterns of urinary steroids ?
Diurnal variation of urinary steroids and its suppression by corticosteroid administration were observed in 6 normal subjects and 33 patients with endocrine disorders during a period of several days.
Urine samples were collected according to the following periods of a day. 1st period : 7A. M.12 N., 2nd period : 12 N.5P. M., 3rd period : 5P M.10 P.M., 4th period : 10 P.M.7 A.M.
The following results were obtained :
(1) In normal subjects, maximal values of both urinary 17-OHCS and 17-KS were seen in the 1st period or the 2nd period, minimal values being seen in the 4th period.
(2) In normal subjects, the pattern of diurnal variation of urinary 17-OHCS was reproducible every day but the reproducibility was not observed at all in cases of the patients.
(3) Dexamethasone was administered at 7 A.M. on the 2nd day in this experiments here described.
(4) The decreasing rate of urinary 17-OHCS and 17-KS due to corticosteroid administration was calculated, and the normal responce rate was more than 30%.
(5) In cases of pituitary disease, abnormal diurnal variations were observed frequently and the decreasing rate of urinary steroids was less than 30%.
(6) In cases of adrenocortical disease, normal diurnal variations were not observed at all. In cases of hypoadrenocorticism, urinary 17-OHCS increased after Dexamethasone administration. In one case of Cushing's Syndrome, urinary 17-OHCS levels during the sleeping time were relatively high but the decreasing rate of urinary 17-OHCS was normal.
(7) In cases of hyperthyroidism, there were no uniform patterns of diurnal variations and of decreasing rates of urinary steroids. In one case of hypothyroidism, a flat diurnal variation and a low decreasing rate were seen.
(8) In all cases of diabetes mellitus, the decreasing rate of urinary steroids was more than 30% and normal diurnal variations were observed in only 2 cases.
(9) In one case of anorexia nervosa, abnormal diurnal variations of urinary 17-OHCS and 17-KS were observed and the decreasing rate of urinary steroids was more than 30%.
(10) The frequency of occurrence of abnormal diurnal variations was 31.2% for 17-OHCS, 27.8% for 17-KS in normal subjects and 67.5% for 17-OHCS, 77.0% for 17-KS in the patients.
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