URINARY EXCRETION OF ADRENAL HORMONES IN GONADAL DYSGENESIS AND ITS RESPONSE TO CORTICOTROPHIN AND GONADOTROPHIN STIMULATION

The functional capacity of the adrenals was studied in eight adult patients with gonadal dysgenesis, ranging in age from 16–42 years, by measuring the 24-hour urinary excretion of 17-hydroxycorticosteroids (17-OHCS) and of 17-ketosteroids (17-KS) with the patient at rest and also by estimating its response to stimulation with corticotrophin and chorionic gonadotrophin.

In six patients the clinical diagnosis of the syndrome was confirmed by laparotomy, when no gonads were found in five patients and a white fibrous band replacing the gonads was found in the other. The remaining two patients of the series both had male sex-chromatin.

The resting excretion of both 17-OHCS and 17-KS was within normal limits in all eight patients.

After corticotrophin stimulation (25 IU infused over 8 hours) an increased 17-OHCS excretion was found in all patients but the increase was less constant for the 17-KS. These results are identical with those expected from normal subjects and were considered to indicate a normal adrenal secretory capacity in the present cases.

Stimulation by chorionic gonadotrophin (HCG test) was performed in four patients using various doses of the hormone, namely 1500 IU for 5 days, 5000 IU for 2 or 5 days, or 10 000 IU for 2 days. Three of these patients had no gonads and the fourth had male sex-chromatin. The HCG test failed to elicit an increased excretion of either 17-OHCS or 17-KS in these patients. This absence of response is regarded as evidence that HCG does not stimulate adrenal tissue to secrete the precursors of these hormones.

The findings of the present study are discussed in the light of previous publications.

CHROMOSOMAL MOSAICISM, X CHROMOSOME ANOMALY AND SEX CHROMATIN DISCREPANCY IN A CASE OF GONADAL DYSGENESIS

The case of a 15-year-old phenotypic female with apparent traits of gonadal dysgenesis, horse shoe kidney and mentally retarded is presented. The sex chromatin was negative as judged from the polymorphonuclear leukocytes, none having been found with a drumstick. In the nuclei of the oral mucosa cells, however, Barr bodies were clearly distinguishable but were unusually small and few in number.

Chromosome preparations made from cultures of leukocytes from the peripheral blood revealed a 45/46 mosaicism. The cells with 45 chromosomes apparently had only one X chromosome. In the other stemline, there was a supernumerary chromosome in the group 17–18, which was judged to be a deleted X

The chromosomal aberration is thought to explain the discrepancy in the findings of sex chromatin.

»Erosions« were frequently found in some of the chromosomes. Their significance is briefly discussed.