title: [Evaluation of urinary excretion of free-cortisol in patients with abnormal pituitary-adrenal axes].
abstract: Since urine contains cross-reacting substances to anti-cortisol(F) antibody, we extracted F from urine samples with dichloromethane. Using this specific assay system for F with TDX dynapack(fluorescence polarization immunoassay system), clinical significance of urinary F was tested by measuring urine samples from normal subjects, patients with pituitary-adrenal diseases and liver cirrhosis, and pregnant. The circadian rhythm of urinary F was evaluated by using samples collected every 4-hour period. The amount of urinary excretions of F during 4 hours were the highest during between 4 a.m. to 8 a.m. and then gradually decreased reaching at the lowest level at between 0 a.m. and 4 a.m. in normal volunteers. Such circadian rhythm was not found in 6 patients with Cushing's syndrome. The urinary F levels in pregnant women started to increase in the samples from between 21 to 30 weeks of gestation, and the level was maintained even at the 5th day of post-partum. The urinary F levels in patients with liver cirrhosis were significantly lower than those for age-matched healthy volunteers. In patients with abnormal steroidogenesis, the urinary F levels in patients with Cushing's syndrome were extremely high, 165-3358 micrograms/day. On the other hands, those in patients with deficient steroid synthetase were 2.8-26.5 micrograms/day, and those in patients with neuroblastoma and pheochromocytoma were 7.8-43.8 micrograms/day. The urinary F levels were about 50-fold higher in the patients with Cushing's syndrome than those in the normal reference interval, whereas serum F and urinary 17-OHCS levels were only 2.5-fold and 7-fold higher than those healthy volunteers, respectively. These results indicate that the assay of urinary F extracted with dichloromethane is the most useful test for the diagnosis of Cushing's syndrome.
authors.affiliation: Central Laboratory, Kanasi Medical University Hospital, Moriguchi.
authors.forename: Y
authors.initials: Y
authors.lastname: Itsuji
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Tanabe
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D002940:Circadian Rhythm; D003480:Cushing Syndrome / Q000175:diagnosis*; D005260:Female; D016231:Fluorescence Polarization Immunoassay / Q000379:methods; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D008297:Male; D008752:Methylene Chloride; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011247:Pregnancy
chemical_list: D015415:Biomarkers; D008752:Methylene Chloride; D006854:Hydrocortisone