Clinical Value of Urinary 17-ketogenic Steroid Determinations

During recent years increasing importance has been attached to the study of adrenal cortical hormones, and consequently much work has been directed towards utilizing the daily output of these hormones and their metabolites in urine as an index of adrenocortical function. Hydrolysis of the conjugated forms in which the steroids are present in urine is a necessary preliminary to their extraction and estimation, but the two common methods of hydrolysis by mineral acid and by P-glucuronidase are not entirely satisfactory, the former causing destruction or alteration of a large proportion of the cortical steroids, the latter not being sufficiently quantitative (Bayliss, 1952). Norymberski and his colleagues (Brooks and Norymberski, 1953; Norymberski, Stubbs, and West, 1953) have obviated the difficulties of hydrolysis by a technique in which the side chain on C(17) is oxidized to a ketone group before hydrolysis, the more stable 17-ketosteroids thus formed being hydrolysed by acid and estimated by one of the established methods. As far as is known, all the important cortical steroids containing a hydroxyl group at C(17), with the exception of 17-hydroxy-20-oxosteroids unsubstituted at C'21), are estimated by this means. It seems probable that this group of steroids, the 17-ketogenic steroids, gives a measurement of the adrenal function concerned with the production of 17 ahydroxycorticosterone (hydrocortisone, Kendall's compound F) which has been shown by Bush and Sandberg (1953) to be the major cortical steroid in human blood. For three years the technique has been used as a routine method of estimation. It has proved to be satisfactory and to give reproducible results. Out of a total of some 3,000 assays, 600, carried out on 400 different patients, were selected as a basis for discussing the clinical utility of the estimation. The cases studied were grouped into those suffering from disorders in which it was known that adrenal cortical dysfunction plays a leading role, and those in which the adrenal may be indirectly affected. Diagnoses were made primarily on clinical evidence.*