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Acebutolol at therapeutic dosage may considerably disturb the determination of urinary 17-oxosteroids by Zimmerman's reaction. This interference, very variable according to the various technics which may be used, depends mainly on the pH of the urine at the time of extraction. In very acid medium (pH less than 1,5) no acebutolol metabolite passes into the solvents of low polarity; in very alkaline medium, (pH greater than 13) the passage la quantitative. The estimation of 17-oxostéroids in the presence of acebutolol, is possible provided the extraction is carried out in sufficiently acid medium, such as that used for hydrolysis in presence of hydrochloric acid. This is moreover the procedure used for classical methods were no interference is observed. The selective estimation of acebutolol and of its metabolites may be carried out simply by Zimmerman's reaction, after extraction at pH 13 of non-hydrolysed urine, thanks to the absence of conjugated derivatives.

The level of different urinary 17-ketosteroids were assayed using a method requiring an enzymatic hydrolysis and a solvolysis, a separation by gas-chromatography on OV 225 (cyanopropylsilicone) and a detection by flame ionisation. The method has been discuted. Statistical study of the results obtained in 89 healthy and ambulatory subjects (divided in 4 groups according to sex and age) has shown a log-normal distribution of urinary excretions.

A 31 years old man with an adrenocortical carcinoma was studied. Clinically he had a bilateral and recidiving gynecomastia and showed high urinary oestrogens, 17 cetosteroids, tetra-hydro-desoxy-cortisol and pregnandiol excretion with normal cortisol production. A partial increase on ACTH, no suppression on dexamethasone and no variation on HCG administration were observed. The surgical resection of the tumor normalized this urinary excretion. The serum dehydro-epiandrosterone (DHEA) and sulfate (DHEAS), oestrone, oestradiol, androstenedione (A) levels were greatly elevated. No variations of the cortisol, A, DHEA and DHEAS was noted after ACTH injection. In vitro the lack of ACTH's action was related to an anomaly of ACTH receptor with normal protein kinase activity.

The authors report on a case where complete blockade of 21-hydroxylase was discovered in a 40-year-old subject. They emphasize the usefulness of urinary 17-ketosteroid and 17-OH progesterone assays in the diagnosis of pseudo-hermaphroditism. In contrast to major hyperandrogenism, the HY antigen test is negative, since the percentage of fluorescent lymphocytes is even lower than in the normal female population.

The authors describe a method of fractionation of urinary 17-oxosteroids after purification of the urinary extract by Girard's T reagent. After solvolysis, enzyme hydrolysis and purification by Girard's T reagent, the 17-oxosteroids were estimated in the form of trimethyl silyl ethers by gas liquid chromatographye on OV 225 using cholesterol acetate for standardisation. The improvement in the quality of the fraction using this technic, the analytical characteristics of which are studied in this work, is of definite interest, in particular after stimulation by ACTH, HCG, metopirone and in the case of pigmentation of the urine.

Seventy seven cases of micropolycystic ovaries were reviewed. All of the patients underwent either coelioscopy or wedge resection of the ovaries. It was thus possible to classify the patients into two groups on the basis of the size of the ovaries (MPCO-A, large ovaries, more than twice the normal size; MPCO-B, ovaries only slightly increased in size or normal). There were differences from a clinical, laboratory and therapeutic standpoint. In MPCO-A, spaniomenorrhea predominated, clinical hyperandrogenism was often absent and 17 ketosteroids lower. Response to hypothalamic gonadotrophic hormone liberation factor was explosive in luteotrophic hormone, but at 120 minutes levels were lower in MPCO-A than in MPCO-B. Wedge resection failed completely in 23% of cases of MPCO-A and in 66% of cases of MPCO-B. This study confirmed current concepts of the heterogeneity of MPCO syndrome.

The DHEAS overload test has been regarded by C. Lauritzen as reflecting the conditions of placental function. Some will support and some will oppose that test. We have merely concerned ourselves with conducting an examination into the metabolic outcome of the DHEAS overload. --by defining the way in which oestriolury variations are best express themselves. --by estimating how reliable such variations are in cases where foetal pain and hypotrophy are diagnosed. --by going through a statistical analysis of other hormonal variations.

The urinary excretion of neutral 17 oxosteroïds has been determined by gas-liquid chromatography on 60 healthy ambulatory senegalese adults of both sexes. Except 11 beta hydroxyandrosteron, all fractions are lower than those usually found among european people.

Interactions between gonadal hormones and adrenocortical function have been studied in the male rat. After injection (im) of testosterone, the accessory reproductive organs are more stimulated in the castrated rats than in the castrated adrenalectomized rats. Gonadectomy increases lipids, cholesterol and corticosterone in adrenal glands and plasma corticosterone levels. Testosterone reverses these effects.

In three young girls with isosexual precocity and fibrous dysplasia of bones, plasma gonadotropins (LH and FSH) response to releasing hormone (LH-RH) has been much under the mean response in true female precocious puberty. These data and those previously reported in the literature suggest that MacCune-Albright's syndrome correlates to an hypothalamo-pituitary dysfunction rather than to a true prematurity.

45 women who were infertile with primary or secondary infertility were studied. The only abnormality that was found was biological, and it was a 24-hour excretion of urinary 17-ketosteroids higher than 35 micromoles. Treatment with cortisone derivatives resulted in 56 pregnancies, which were studied to their term whether it was abortion or delivery. The theoretical and practical aspects, as well as the diagnoses and treatments, are discussed.

The 24-hour urinary excretion rates of creatinine, vanilmandelic acid (VMA), 17-hydroxycorticosteroids, 17-ketosteroids were analysed in 30 female twin pairs. For each of these variables, a comparative study based on the breakdown of total variance into interpair and intrapair variance was undertaken, first on identical (MZ) and fraternal (DZ) twins and then on twins who live together or separately. The comparison of test results shows a strong likeness in the MZ group and in the living together group with respect to the urinary excretion of 17-OH. The variability of VMA excretion can be explained by genetic factors while the variability of 17-ketosteroids and creatinine can be explained with reference to environmental factors.

Thirty-four cases of corticosurrenaloma with clinical onset before 15 years of age have been studied. Higher frequency in girls (65 percent of the cases) and in young age (80 percent before 5 years of age, 43 percent before 2 years), association with personal or familial other tumors and malformations, are noticeable features. Virilism is the major manifestation in children (83 percent of the cases), either isolated or associated with hypercortisolism and/or feminization. Hormonal assays are of little value, and the dynamic adrenal tests are of some help only in small tumors or isolated hypercortisolism. Radiological diagnosis by urography with cavography, arteriography, is easy in most cases. Evaluation of prognosis is very difficult. Clinical and biological data are not significant, histological data are often of little help. Only a very large mass, and occurrence of metastases (liver, lungs) evidence malignancy. This series does not allow to assess definitely the best therapeutic regimen. Surgery has to be performed as soon as possible. The effects of radiations have not yet been ascertained. High doses of op'DDD have led to a sustained remission of the tumor or metastases in 2 patients, and perhaps to a longer survival in 4 others.

Three cases of virilizing tumors of the adrenal gland are reported. Two were malignant and are briefly summarized, and the other was benign. A review of the literature concerning benign virilizing tumors of the adrenal is included.

A semi-automated determination of 17-oxosteroids in urinary extracts is described using a modified Zimmerman reaction in aqueous phase according to Epstein. In order to eliminate the interfering chromogens a double manifold and a double-beam colorimeter are used in continuous flow. The spectra and the chromogenecity of seven different 17-oxosteroids are presented. The specificity and the reproducibility of this technique are good and the comparison with gas-liquid chromatography and manual Zimmerman reaction shows a good correlation.

Adrenocortical carcinoma (ACC) is a rare disorder with an estimated incidence of only 0.023 percent of all malignancies. In most cases, Cushing's syndrome and virilization or feminization due to abnormal steroid production by the tumor rapidly lead to the diagnosis. Occasionally, the tumor produces an excessive amount of mineralocorticoids only and ACC can be revealed by an isolated syndrome of primary aldosteronism. Out of 100 cases of tumoral primary aldosteronism studied from 1977 to 1987, we observed 4 ACC and 96 Conn's adenomas (CONN). When primary aldosteronism was diagnosed, ACC and CONN had same clinical features, although hypokalemia in ACC was more profound: 2.2 +/- 0.76 mmol/l (1.4 to 3.2) compared to 2.9 +/- 0.5 (1.6 to 4.2) in CONN. Mean supine plasma aldosterone levels, plasma renin and aldosterone responses to the upright posture or to serum saline infusion, cortisol at 8 a.m. were not different in patients with ACC from those observed in patients with CONN. 24 hours urinary cortisol excretion and 17-ketosteroids excretion were highly increased in three out four patients with ACC. Clinical, biological and hormonal investigations were therefore not sufficient to diagnose malignant tumoral primary aldosteronism. Systematic computed tomographic scanning allowed to differentiate carcinomas from adenomas on the following criteria: ACC showed enlarged tumor size that was always above 30 mm in diameter, whereas the largest CONN measured 20 mm.ACC appeared as an heterogeneous tumor with the presence of internal calcifications in each case of ACC, that were diagnosed both on ultrasound and CT scan, whereas none of the CONN showed any calcification, using the same screening procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Bamifylline in therapeutic dosage may markedly disturb the determination of urinary 17-oxosteroids by Zimmermann's reaction, although the conditions of extraction and formation of this chromogenic substance are not always optimal for the metabolites of bamifylline. It is easy to suspect this interference as the chromogenic substance is produced as soon as the reagents are introduced, contrary to 17-oxosteroids, and it presents a more bluish colour. It is possible to separate completely both types of metabolite by washing the chloroform extracts with acid solutions which form salts with bamifylline and thus extract it. From these acid solutions, bamifylline may be recovered and estimated Zimmermann's reaction which is, for this purpose, modified.

The extraction ot total urinary 17-keto and 17-hydroxy steroids has been effected by a rapid procedure involving pre-packed kieselguhr column chromatography. This work successively studies the correlation of this technique with the classical extraction by mechanical agitation (42 and 61 subjects), its reproducibility, repeatability and recovery of added internal standards. The proposed method seems convenient for routine clinical analysis.

The authors present the case of a young hirsute woman of 28 years old. Urinary 17 KS were very increased without DHA, but with androsterone, etiocholanolone and 11 oxy 17 Ketosteroids. Androstenedione and testosterone plasmatic levels were very high and per operative selective ovarian vein catheterization showed a direct production of these potent androgens. In vitro study of the tumor allowed to obtain same results. Light and electron microscopic study showed a Leydig cell tumor of left ovary.

Starting from 48 cases of gynecomastia, the authors report the following findings: -- Impairment of the testis function, as assessed by a low plasma level of testosterone, is rare. -- Basal values of gonadotropins are generally normal. -- Increased oestrogen urinary excretion and blood level are rarely found but, when present, they tend to decrease at successive evaluations. -- In six cases, plasmatic oestradiol can be suppressed by dexamethasone; although the small number of cases does not allow a definite conclusion, one might suggest a predominant adrenal source of plasmatic oestradiol.

Electrolytes disturbances during operative period are believed to be related to an hyperaldosteronism produced by anaesthetic management and surgery. Effects of ethrane anaesthesia and surgery on hydroelectrolytic metabolism and endocrin function were investigated in 11 patients submitted to an abdominal surgery. Plasma and urinary levels of aldosterone were increased (x3) significantly (p less than or equal to 0.001) during operation, then decreased gradually in post-operative period, and return to normal values when Na/K ratio is reversed in urines. Relationship between hyperaldosteronism and other changes in endocrine function are established by determination of following hormones: A.C.T.H., cortisol, plasma renin activity (P.R.A.) catecholamines in plasma and urinary levels of 17-ceto, 17-hydroxysteroids and catecholamines. Ethrane anesthesia give a good neurovegetative stability since plasma catecholamines levels are not affected significatively. Plasma aldosterone level is correlated with urinary aldosterone and plasma renin activity. Plasma A.C.T.H. is much more increased at the operative time and decreases rapidly instead of plasma cortisol which decreases more slowly. Relationship of this hyperaldosteronism with anesthetic management, surgical stress intestinal transit disturbances, other endocrine function changes is discussed.