Apparent activities of 21-hydroxylase, 17alpha-hydroxylase and 17,20-lyase are impaired in adrenal incidentalomas
| Autor: | J. L. Sadoul, B Kezachian, Canivet B, Y Hadjali, S Altare |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adenoma
Adult Male endocrine system medicine.medical_specialty Hydrocortisone Endocrinology Diabetes and Metabolism Cortodoxone Adrenal Gland Neoplasms Dehydroepiandrosterone 17-alpha-Hydroxypregnenolone Dexamethasone chemistry.chemical_compound Endocrinology Dehydroepiandrosterone sulfate Adrenocorticotropic Hormone Internal medicine Adrenal Glands Renin medicine Humans Prospective Studies Desoxycorticosterone Aldosterone Glucocorticoids Progesterone Aged Aged 80 and over biology medicine.diagnostic_test business.industry Androstenedione 21-Hydroxylase ACTH stimulation test Steroid 17-alpha-Hydroxylase General Medicine Middle Aged chemistry Dexamethasone suppression test biology.protein Female Steroid 21-Hydroxylase business Glucocorticoid medicine.drug |
| Zdroj: | European Journal of Endocrinology. :238-245 |
| ISSN: | 1479-683X 0804-4643 |
| DOI: | 10.1530/eje.0.1410238 |
| Popis: | OBJECTIVE: An increased response of 17-hydroxyprogesterone to ACTH stimulation has been observed in adrenal incidentaloma and linked to an impairment of either 21-hydroxylase or of 11beta-hydroxylase activity. To analyse this question further, we investigated the steroidogenic pathways in a series of 17 adrenal incidentalomas. DESIGN AND PATIENTS: 17 patients (7 women, 10 men; mean age, 62 +/- 12 years) with non-histologically analyzed adrenal incidentalomas were prospectively evaluated. METHODS: The following variables were investigated: 24-h urinary methanephrines and free cortisol excretion; plasma levels of ACTH and dehydroepiandrosterone; overnight dexamethasone suppression test; 1-24 ACTH stimulation test with measurement of: cortisol, 11-deoxycortisol, 17-hydroxyprogesterone, aldosterone, 11-deoxycorticosterone, progesterone, 17-hydroxypregnenolone, Delta4-androstenedione, dehydroepiandrosterone and 21-deoxycortisol. RESULTS: Discordant features of subclinical hypercorticism were noted in one case. No patient had dehydroepiandrosterone sulfate levels in the normal range for his or her age. Peak 17-hydroxyprogesterone and peak 21-deoxycortisol disclosed impairment of 21-hydroxylase in 11 and 10 cases respectively. An increased 11-deoxycortisol/cortisol ratio identified reduced activity of 11beta-hydroxylase in 11 patients. Eight patients displayed features of mild 17,20-lyase impairment, which was related to 21-hydroxylase dysfunction. Whereas only 2 patients showed no enzyme modification, 9 displayed alterations of at least two pathways. CONCLUSION: In our hands, a combination of enzyme dysfunction was frequently observed. Shared biochemical mechanisms could explain combined 17,20-lyase and 21-hydroxylase alterations, whereas coexistence of 21-hydroxylase (particularly when based on peak 21-deoxycortisol) and 11beta-hydroxylase is more puzzling. |
| Databáze: | OpenAIRE |
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