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KMID : 0882419770200111001
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Korean Journal of Medicine
1977 Volume.20 No. 11 p.1001 ~ p.1006
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The Measurement of Plasma Cortisol in the Patients with Adrenocortical Dysfunction by Radioimmunoassay
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Kim Chong-Sang
Kang Moon-Won
Bang Byung-Kee
Won Un-Sik
Shin Kyoung-Sup
Kim Ki-Ho
Choi Young-Kil
Min Byong-Sok
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Abstract
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In quantitative: assay of plasma cortisol, Porter-Silber method and fluorometric method have been used for many years but are not satisfactory because of low specificity and technical difficulty. Lately popularized competitive protein binding assay has also some disadvantages that affinity of corticosteroid binding globulin to cortisol is low and separation of free from bound cortisol is difficult. Recently radioimmunoassay (RIA) for cortisol was developed and proved highly specific, accurate and technically simple.
The purpose of this study is to evaluate the diagnostic valve of the measurement of the plasma cortisol concentration in the patients with adrenocortical dysfunction. Plasma cortisol was measured by RIA. Commercially available RIA kits were used.
The results are as follows;
1) The plasma cortisol level at 8 AM was 11.7±4.7μg/dl in 7 normal subjects; very low in 2 subjects with Addison´s disease; low in 10 subjects with Sheehan´s syndrome except 3 subjects who had the near normal level.
2) The increase in plasma cortisol concentration after intravenous ACTH infusion was not noted at all in 2 subjects with Addison´s disease but variable in 10 subjects with Sheehan´s syndrome; normal response in 3 subjects, no response in other 3 subjects, and intermediate response in the remainder.
3) In a patient with Cushing´s syndrome due to tumor in the left adrenal cortex, who had high plasma cortisol concentration in peripheral venous blood, the cortisol concentration of left adrenal venous blood was considerably higher than of right in addition to abnormal left adrenal venogram.
It is concluded that the measurement of plasma cortisol by RIA is valuable in the diagnosis of the adrenocortical dysfunction, especially adrenal insufficiency that requires prompt diagnosis and treatment and in the localization of the lesion of the Cushing´s syndrome.
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