Clinical Studies on the Stimulation and Suppression in the Pituitary-Adrenocortical System

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  • SAKO Yoshiyasu
    Second Division, Department of Internal Medicine, Faculty of Medicine, Kyoto University

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Other Title
  • 下垂体副腎皮質系の刺激および抑制に関する臨床的研究
  • 下垂体副腎皮質系機能の抑制試験に関する研究
  • カスイタイ フクジン ヒシツケイ キノウ ノ ヨクセイ シケン ニ カンスル ケンキュウ
  • II. Studies on the suppression test of the pituitary-adrenocortical system
  • 第二編 下垂体副腎皮質系機能の抑制試験に関する研究

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In order to evaluate the usefulness of dexamethasone suppression test for the diagnosis of certain clinical disorders which show elevated urinary 17-OHCS excretion, the effects of small and large doses of dexamethasone on urinary 17-OHCS excretion were studied in normal subjects, patients with simple obesity, Cushing's syndrome and hyperthyroidism. Urinary 17-OHCS excretion was measured by means of a modification of the method of Reddy, Jenkins and Thorn. Dexamethasone was administered for 9 days in the following way : 1.0 mg. daily for 3 days, 2.0 mg. daily for 3 days and 8.0 mg. daily for 3 days, in 4 divided doses.<BR>1) Urinary 17-OHCS excretion in 5 normal subjects and 7 patients with simple obesity was suppressed by a daily administration of 1.0 mg. of dexamethasone for 3 days. Urinary 17-OHCS was rather more markedly suppressed in patients with simple obesity than in normal subjects.<BR>2) Urinary 17-OHCS excretion in 2 patients with Cushing's syndrome due to bilateral adrenocortical hyperplasia was not suppressed by the daily administration of 1.0 mg. of dexamethasone for 3 days. Therefore, Cushing's syndrome in patients can be clearly differentiated from normal subjects or patients with simple obesity by this test. Urinary 17-OHCS excretion was occasionally suppressed in patients with Cushing's syndrome by the daily administration of 2.0 mg. of dexamethasone for 3 days. It seems to be pertinent, therefore, to administer 1.0 mg. of dexamethasone daily for the purpose of differentiating Cushing's syndrome from simple obesity.<BR>3) Daily administration of 8.0 mg. of dexamethasone for 3 days did not suppress urinary 17-OHCS excretion in 3 patients with Cushing's syndrome due to adrenocortical adenoma, but suppressed it to the level lower than 5.0 mg. /day in 2 patients with bilateral adrenocortical hyperplasia. Therefore, adrenocortical adenoma can be differentiated from bilateral adrenocortical hyperplasia in Cushing's syndrome by giving 8.0 mg. of dexamethasone for 3 days.<BR>4) Suppressibility of the daily urinary 17-OHCS in 6 patients with hyperthyroidism was almost equal to that in normal subjects by the daily administration of 1.0 mg. of dexamethasone for 3 days, although the actual values of the daily urinary 17-OHCS were higher than those of normal subjects.

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