On the rate of hydrocortisone clearance from plasma in pregnant women and in patients with Laennec's cirrhosis.

The question of whether or not there is an increase in adrenal cortical secretion during pregnancy remains unsettled. Morphologic studies of the adrenal during gestation have revealed enlargement of the gland in some species (1) and no enlargement in others (2). In the human female, several groups of investigators have observed a progressive rise in the plasma 17-hydroxycorticosteroid (17-OH-corticosteroid) level during pregnancy (3-8). Paper chromatographic studies (9), confirmed in this laboratory (10), have indicated that the elevated plasma 17-OH-corticosteroid level is due to an increase in circulating hydrocortisone, and not to a nonspecific chromogen. Measurement of urinary 17-OH-corticosteroids has given equivocal results. Jayle, Desgrez, Serpicelli and Rozeg (11), Devis (12), Mills (13), and Appleby and Norymberski (14) found that the rise in urinary 17-OH-corticosteroids and 17-ketogenic steroids during pregnancy was of only moderate degree. Contradictory results have been obtained from studies of urinary 11-oxygenated 17-ketosteroids, the principal C19 metabolites of hydrocortisone (15). Dobriner, Lieberman, Rhoads and Taylor (16) and Davis and Plotz (17) reported that urinary 11-oxygenated 17-ketosteroids did not increase with advancing gestation, while Huis in't Veld (18) and Birke, Gemzell, Plantin and Robbe (19) claimed that these steroids were present in increased quantity in the third trimester. In an attempt to reconcile the apparent dis-