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Chapter 525: Evaluation of Adrenal Function

Walter L. Miller

INTRODUCTION

The diagnostic evaluation of adrenal function depends largely on chemical measurements of circulating steroid levels or excretion of their urinary metabolites. Stimulation tests can help localize pathology. Clinical symptoms and signs generally lack sensitivity or specificity, and imaging studies are rarely helpful.

PLASMA STEROIDS

The plasma concentrations of cortisol and other steroids can screen for adrenal disorders and provide clues regarding specific enzymatic deficiencies. Tables 525-1 and 525-2 summarize the normal plasma concentrations for a variety of steroids. With the notable exception of dehydroepiandrosterone sulfate (DHEAS), most adrenal steroids exhibit a diurnal variation based on the diurnal rhythm of corticotropin (ACTH). Because the stress of illness or hospitalization can increase adrenal steroid secretion and because diurnal rhythms may not be well established prior to 3 years of age, it is best to obtain 2 or more samples for the measurement of any steroid.

TABLE 525-1MEAN SEX STEROID CONCENTRATION IN INFANTS AND CHILDREN
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TABLE 525-1MEAN SEX STEROID CONCENTRATION IN INFANTS AND CHILDREN
Testosterone DHT
PROG 17OHP DHEA DHEAS Δ4 A E1 E2 M F M F
Cord blood 1100 62 21 6400 3.0 52 30 1.0 0.9 0.2 0.2
Premature newborns 11 8.1 28 11,000 7.0 4.2 0.4 1.0 0.1
Term newborns 1.1 20 4400 5.2 6.9 1.4 0.9 0.3
Infants 1.0 1.0 3.8 820 0.7 < 0.1 < 0.1 6.6 < 0.4 1.4 < 0.1
Children 1–6 years 1.0 270 0.9 < 0.1 < 0.1 0.2 0.1
Children 6–8 years 3.1 540 0.9 < 0.1 < 0.1 0.2 0.1
Children 8–10 years 5.6 1400 0.9 < 0.1 < 0.1 0.2 0.1
Males
 Pubertal stage I 0.6 1.3 5.6 950 0.9 0.0 0.0 0.2 < 0.1
 II 0.6 1.6 10 2600 1.6 0.1 0.0 1.4 0.3
 III 0.8 2.0 14 3300 2.4 0.1 0.1 6.6 0.7
 IV 1.1 2.6 14 5400 2.8 0.1 0.1 13 1.2
 V 1.3 3.3 17 6300 3.5 0.1 0.1 19 1.6
 Adult 1.1 3.3 16 7300 4.0 0.1 0.1 22 1.7
Females
 Pubertal stage I 0.6 1.0 5.6 1100 0.9 0.1 0.0 0.2 0.1
 II 1.0 1.6 11 1900 2.3 0.1 0.1 0.7 0.3
 III 1.3 2.3 14 2500 4.2 0.1 0.1 0.9 0.3
 IV 9.2 2.9 15 3300 4.5 0.1 0.2 0.9 0.3
 V 5.1 3.6 19 4100 6.0 0.2 0.4 1.0 0.3
 Adult
  Follicular 1.0 1.5 16 4100 5.8 0.2 0.2 1.0 0.3
  Luteal 24 5.4 16 4100 5.8 0.4 0.5 1.0 0.3

All values are in nmol/L. To convert these values to ng/dL, multiply nmol/L times the following values: androstenedione, 28.6; DHEA, 28.8; DHT, 29.0; E1, 27.0; E2, 27.2; PROG, 31.5; 17OHP, 33.1. To convert DHEAS to μg/dL, multiply by 0.0368.

Δ4 A, androstenedione; 17OHP, 17 hydroxyprogesterone; DHEA, dehydroepiandrosterone; DHEAS, dehydroepiandrosterone sulfate; DHT, dihydrotestosterone; E1, estrone; E2, estradiol; F, female; M, male; PROG, progesterone; T, testosterone.

Data from Endocrine Sciences, Tarzana, California.

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