DISSOCIATION OF CORTISOL AND ADRENAL ANDROGEN SECRETION IN PATIENTS WITH SECONDARY ADRENAL INSUFFICIENCY

Plasma cortisol, dehydroepiandrosterone (DHA), dehydroepiandrosterone sulfate (DHAS) and androstenedione (.DELTA.4-A) were measured by RIA [radioimmunoassay] during ACTH infusion in preadrenarchal children with constitutional short stature, normal adults and patients with secondary adrenal insufficiency resulting from hypothalamic-pituitary disease or corticosteroid therapy. The plasma levels of all four steroids were decreased in patients with secondary adrenal insufficiency compared to normal adults, but the decrease in DHA and DHAS was considerably greater than that in cortisol and .DELTA.4-A, resulting in significant decreases in the plasma ratios of DHA to cortisol, DHAS to cortisol, DHA to .DELTA.4-A and DHAS to .DELTA.4-A (P < 0.00001). The decreased DHA and DHAS responses to ACTH persisted in 1 glucocorticoid-treated patient after glucocorticoid therapy was terminated and the cortisol response to ACTH had normalized. Adrenal atrophy due to hypothalamic-pituitary disease or corticosteroid therapy is apparently associated with a greater impairment in the secretion of the .DELTA.5 adrenal androgens DHA and DHAS than in the secretion of cortisol and .DELTA.4-A, and the capacity to secrete cortisol and .DELTA.4-A recovers more rapidly than the capacity to secrete the .DELTA.5 adrenal androgens when corticosteroid therapy is withdrawn.