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December 12, 1966

The Signs Of Adrenal Malfunction

JAMA. 1966;198(11):47. doi:10.1001/jama.1966.03110240021012

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In making a diagnosis involving adrenal dysfunction, the physician should keep in mind that abnormalities of steroids other than aldosterone can produce the signs and symptoms of what is usually called primary aldosteronism.

Although aldosterone is the most potent of the mineralocorticoids, excessive secretion of deoxycorticosterone and corticosterone will produce the same physiological effects —hypertension, hypokalemia, alkalosis, and hypervolemia.

Case History  To illustrate this point, Edward G. Biglieri, MD, described to physicians at the Clinical Convention the case history of a 36-year-old woman who presented with the classical signs of an aldosterone-producing tumor. There was, however, no aldosterone present in her urine."The only steroids she was making were deoxycorticosterone and corticosterone," Dr. Biglieri said. "The production of these was enormous."The 24-hour excretions of deoxycorticosterone and corticosterone were 4.5 mg and 112 mg as compared with respective normal excretion rates of 0.3 mg and 4.4 mg.

Enzymatic Defects  This