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Testicular venous effluent was obtained by selective catheterization from 2 subjects with chromatin-positive Klinefelter's syndrome. In both of these subjects the testosterone concentration was reduced, whereas the estradiol concentration was normal or slightly increased in 1 and reduced to a much lesser extent than the testosterone level in the other. The testosterone/estradiol ratios in both subjects were in the range of 180, whereas in the normal subjects the mean testosterone/estradiol ratio in the spermatic venous effluent was 582.

Hyperfunctioning non-neoplastic adrenal glands may be associated with Cushing's syndrome, congenital adrenal hyperplasia, and aldosteronism. The problems in radiographic diagnosis may be resolved by correlation of the angiogram with the clinical and laboratory findings.

Four insulin-deprived patients with diabetes mellitus and normal baseline potassium and aldosterone levels became hyperkalemic when given 100 g of glucose orally. The increases in plasma potassium concentrations averaged 1.3 mEq/L (range, 0.7 to 1.8 mEq/L) and were accompanied by increases in plasma aldosterone level. Four other insulin-deprived diabetics had normal plasma potassium and aldosterone responses when given 50 mEq of potassium chloride orally. These findings suggest that glucose-induced hyperkalemia is not infrequent in diabetics and that it is not usually associated with hypoaldosteronism. The acute suppression of aldosterone biosynthesis with aminoglutethimide did not lead to increased plasma potassium levels following oral potassium loads. This suggests that the acute responses of aldosterone to potassium loads may not be important in preventing postprandial hyperkalemia.

Testicular function in the patient with Klinefelter's syndrome parallels the alterations seen with age in the normal subject. Significant decreases are seen in the Klinefelter group in the plasma level of testosterone and in the plasma testosterone/oestradiol ratio. Testicular function in the patient with Klinefelter's syndrome appears very much like that seen in a chronologically older subject.

A 28-year-old man with evidence of feminization was demonstrated after 4 years of investigation to have a estrogen-secreting interstitial cell tumor. Such feminizing neoplasms are uncommon, only 37 having been described. They are usually benign and are characterized by gynecomastia, a testicular mass and, with lesser frequency, by decreased libido and potency and poor semen quality. The urinary excretion and plasma levels of estrogen are increased and, by selective testicular catheterization, the site of increased estrogen production can be localized. Secondary histologic changes occur in the nontumorous portions of the testis as well as in the contralateral testis; they are most marked in the area immediately adjacent to the tumor. Postoperatively, the gynecomastia regresses, the excessive levels of estrogen return to normal, libido improves, and the sperm count increases to normal.

Measurement of the peripheral vein levels of the steroids in the adrenal biosynthetic pathway affords a further possible definitive method of differentiating adrenocortical carcinoma from adrenal adenoma in the presence of Cushing syndrome. In patients with adrenal carcinoma the blood levels of 17-hydroxyprogesterone, testosterone, androstenedione, and dehydroepiandrosterone are far higher than those seen in association with adenoma. In addition, the adrenal cortical carcinoma appears to have a higher ratio of precursors to product in the early part of the biosynthetic path and a lower one in the distal portion than adrenal adenomas. In Cushing syndrome due to adrenal tumor the measurement of serum cortisol is preferably made after chromatographic separation from 11-deoxycortisol in view of the marked cross reactivity in the protein binding procedure.

A 15-year-old girl with primary amenorrhea, hirsutism, and enlargement of the clitoris was found to have an increased titer of the urinary neutral 17-ketosteroids which failed to decrease after the administration of dexamethasone and an adrenal tumor was demonstrable on venography. Analysis of the adrenal venous effluent revealed gradients on the side of the tumor for testosterone, androstenedione, estradiol, and dehydroepiandrosterone sulfate. Following removal of the tumor, the hirsutism improved markedly, the menses returned, and sexual maturation progressed.