Biosynthesis of various steroids in vitro by isolated adrenal cells in primary aldosteronism, Cushing's syndrome, and adrenogenital syndrome due to adrenocortical adenoma.

To a further understanding of the role of steroid hormones in adrenal disorders, we have prepared free cell system of adrenal cells, using adrenal tissues thai had been removed by operation from (i) cases of Cushing's syndrome due to adrenocortical adenoma or adrenocortical hyperplasia, (ii) a case of primary aldosteronism, and (iii) a patient with virilizing adrenal tumor. Twelve important steroid hormones were measured, such as pregnenolone, cortisol and aldosterone, which were produced by these cells. Adrenal glands removed from the cases of advanced breast cancer were used for the measurement of steroids as a control. No organic lesions were confirmed in these adrenal glands. An investigation as to what characteristics the adrenal cells with various disorders show, had been carried out by examining the patterns of their steroid hormone production. The results were as follows: It was not the case that adenoma cells of each disorder produced just one of three types of steroid hormones, that is, glucocorticoids, mineralocorticoids, and androgens. In fact, it is interesting enough that each adenoma produced all steroid hormones. But, the quantitative pattern of each steroid hormone production differed characteristically from one disorder to the other. It was discovered that the symptom varies depending on the amount of the more predominantly produced hormone among these steroid hormones. Consequently, adrenal disorders can be classified into the three types before-mentioned. It seems that symptoms of these disorders were also modified by other steroid hormones being produced simultaneously. Cells of adenoma in the cases of Cushing's syndrome produced a fair amount of mineralocorticoids as well as cortisol. That is why hypokalemic alkalosis and hypertension in this disorders developed. In the case of Cushing's disease due to adrenal hyperplasia, steroid hormone production pattern was similar to that in the control. In the case of virilizing adrenal tumor, androgens were predominantly produced, with the increased production of cortisol. In fact, the latter finding was consisted with the patient's Cushingoid appearance. It was also discovered that the quantitative proportion of the various steroid hormones produced by isolated adrenal cells, varied depending on the cells which were placed on the different conditions. In the case of Cushing's syndrome due to adrenocortical adenoma, for example, the quantitative proportion of mineralocorticoids was higher where no ACTH was added to the medium, compared to that where ACTH was added. These results appear to correspond with the clinical findings of the above-mentioned disorders. And, it can be said that these data are convincing for explaining the clinical symptoms.