Adrenal cortical steroidogenesis and adrenal androgen secretion in Cushing disease

Abstract

The daily time course of changes In the secretion of dehydroepiandrosterone, its sulfate, and Cortisol, as well as their precursors (17-α-hydroxypregnenolone, 17-α-hydroxyprogesterone, and 11-deoxycortisol) was studied in patients with Itsenko-Cushing syndrome and disease. The mean daily blood concentrations were calculated for each hormone. The activity of the enzymatic systems of steroidogenesis was estimated from the ratio of the mean daily concentrations of the precursor of an enzymatic reaction to those of its product. The findings suggest that production of elevated concentrations of corticosteroids (both Cortisol and androgens) through the Δ⁵-pathway with the enhanced activity of 11β-hydroxylase and sulfatase is characteristic of patients with Itsenko-Cushing disease. In patients with Itsenko-Cushing syndrome, the generation of higher Cortisol levels is accomplished through the Δ⁴-pathway whereas the synthesis of androgens through the Δ⁵-pathway is minimal due to the decreased activity of 17,20-desmolase.