Adrenal Steroid Stimulation

Twenty four-hour urinary output measures the “entire picture” rather than just a single-moment-in-time “snapshot” or even four “snapshots” at different times during the day. This 24 hour output measurement avoids misdiagnosing individuals whose diurnal rhythm isn’t what “the textbook” says it should be.

The androgen, dehydroepiandrosterone (DHEA), and its downstream metabolites, etiocholanolone, are stimulated by Cortrosyn or ACTH injection. Expected stimulated excretion is 50% or more over baseline excretion.1 Because of rapid metabolism, the sum of the three should be evaluated as a whole instead of each compound individually. For example, if the DHEA value is low, but the etiocholanolone and androsterone are in the middle or upper end of the reference range, total DHEA metabolites would be considered normal. ACTH also stimulates the glucocorticosteroids, cortisone and cortisol. As these two metabolites are physiologically “interchangeable”, they may be summated. The sum of these should increase 100% or more after stimulation.1

The mineral corticosteroid, aldosterone, is stimulated to a small extent and an increase of 25-50% is expected.1 Failure to achieve these expected increases can indicate failure of adrenal reserve capacity.1 In many cases, the test shows no increase after ACTH injection. Patients showing this pattern are producing at a maximum level and increased stress shows no additional response.

Some patients decrease in the amount of hormones excreted after stimulation. This collapse of the adrenals with stress demonstrates the “whipped horse” phenomenon. The adrenals function daily under constant stress due to environmental or physical factors and collapse when the stress is increased.

Treatment and dosages can be found in the following references.

REFERENCE

1. Tintera, J., MD Hypoadrenocorticism, 1980, 9th Printing
2. Jefferies, W., MD Safe Uses of Cortisone, Charles C. Thomas, Springfield, IL, 1981.

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