THE RELIABILITY OF SOME ADRENAL FUNCTION TESTS

Journal/Book: BRITISH MEDICAL JOURNAL November 28 1959 vol. ii. pp. 1117-1122. 1959;

Abstract: C. L. COPE D.M. F.R.C.P. AND E. G. BLACK B.SC. From the Department of Medicine Postgraduate Medical School London Summary Adrenal-function tests vary widely in their sensitivity to different conditions and therefore in their suitability for various purposes. Urinary cortisol excretion is more than twice as sensitive as ketogenic steroid excretion for demonstration of adrenal hyperactivity and for detecting inhibition of such hyperactivity. Urinary cortisol excretion is unsuitable for detecting adrenal hypofunction but this is sensitively revealed by measuring the main cortisol metabolites-tetrahydro-cortisol and tetrahydrocortisone - in the urine. Excretions as low as 5% of normal can still be measured with sufficient accuracy. The excretion of various steroids and steroid groups has been compared with the daily cortisol production rate measured by isotopic means. There is no relation between 17-ketosteroid excretion and the daily cortisol production. There is a poor correlation between daily cortisol production and urinary cortisol excretion. At high rates of adrenal activity the urinary excretion of 17-ketogenic steroids is approximately half the daily cortisol production. In low normal or moderately raised adrenal activity the correlation between cortisol production rate and 17-ketogenic steroid excretion is poor and no conclusions justified about the former from the magnitude of the latter. Adrenal function tests need to be carefully selected for their suitability for the purpose intended. ___MH

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