Wolfgang G. Sippell

Simultaneous radioimmunoassay of plasma aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol and cortisone.

Abstract A method for the simultaneous determination of eight major corticosteroid hormones and precursors in 0.5–2.0 ml of plasma has been developed and is described in detail. After extraction of the unconjugated steroids from plasma to which tritiated steroid tracers had been added, progesterone (P), 11-deoxycorticosterone (DOC), 17-hydroxyprogesterone (17-OH-P), corticosterone (B), 11-deoxycortisol ( S ), aldosterone (A), cortisone (E) and cortisol (F) are simultaneously separated using eight mechanized 60 cm Sephadex LH-20 columns in parallel. Each of the isolated steroids is quantitated by radioimmunoassay after saving an aliquot for recovery counting. The combination of Chromatographic separation and appropriate antiserum resulted in high assay specificity. Water or steroid-free plasma blanks were undetectable, with sensitivities of the assays ranging between 0.020 (A) and 0.370 (E) ng/ml. There was very satisfactory precision and accuracy, with inter-assay coefficients of variation below 16.5% and linear relationships between added and found, respectively. Normal values are reported for males, females (follicular phase) and a small group of prepubertal children, revealing sex differences between the adults studied with higher A, B and P levels in females and higher 17-OH-P and E levels in males. The mineralocorticoids A and DOC were considerably higher in children than in adults. The highly practicable method is particularly useful in pediatric and experimental endocrinology.

Simultaneous determination of seven unconjugated steroids in maternal venous and umbilical arterial and venous serum in elective and emergency cesarean section at term

In order to assess specific gluco- and mineralocorticoid functions in both mother and fetoplacental unit in relation to the presence or absence of labor, serum levels of unconjugated aldosterone (A), corticosterone (B), deoxycorticosterone (DOC), progesterone (P), 17-hydroxyprogesterone (17-OHP), cortisol (F), and cortisone (E) were determined simultaneously. These levels were determined by specific radioimmunoassays in two groups of 24 paired maternal venous and umbilical arterial and venous samples obtained at term delivery by either elective (Group I, N = 8) or emergency (Group II, N = 8) cesarean section. In Group II, after spontaneous labor, mean maternal serum levels of all steroids investigated exceeded those found in Group I (not in labor). These increases were most pronounced (p less than 0.005) in F (74%) and DOC (106%) levels demonstrating stimulation of both the glucocorticoid (cortisol)--and the mineralocorticoid (aldosterone)--producing pathways of the maternal adrenals by spontaneous labor. Arteriovenous differences in umbilical steroid levels revealed in both groups the placental origin of P, 17-OHP, and E (p less than 0.05 to 0.005), with greater (more negative) mean AV differences after labor (Group II). The negative AV difference of DOC, B, A, and F found in Group I, however, decreased after labor and became even positive in the cases of B and F, reflecting the close relationship between spontaneous labor and the fetal adrenals active production not only of the glucocorticoids B and F, but also, to a lesser extent, of the mineralocorticoids DOC and aldosterone.

Development of endogenous glucocorticoids, mineralocorticoids and progestins in the human fetal and perinatal period

SummaryCorticosteroids (CS) are known to be essential for fetal organ maturation and seem to play an important role in both the initiation of parturition and the postnatal adaptation of the human neonate. Pharmacologically, CS are widely used for enhancing fetal lung maturation prior to premature delivery. However, knowledge of endogenous CS and precursor levels throughout fetal and perinatal life and their response to exogenous CS is limited. Therefore, using automated liquid column chromatography plus specific radioimmunoassays, unconjugated aldosterone (Aldo), corticosterone (B), 11-deoxycorticosterone (DOC), progesterone (P), 17-hydroxyprogesterone (17-OHP), 11-deoxycortisol (S), cortisol (F) and cortisone (E) were simultaneously followed in 70 amniotic fluid (AF) control samples throughout pregnancy, and in cord and neonatal plasma longitudinally during the first week of life. From 14 to 38 weeks, AF levels of all measured steroids except E rose by 2 to 12-fold on the average (allP<0.001) but declined at term. E increased until 31–35 weeks (P<0.01), then remained almost constant until term. Cord levels of all steroids were substantially higher than those found in AF at term. While levels of the placentally derived steroids P, 17-OHP, DOC and E dropped sharply after birth by several orders of magnitude (P≪0.01) showing typical disappearance curves, the biologically most potent CS Aldo and F rose even further immediately after birth. Whereas Aldo levels declined from maxima about 100 times above normal adult levels at 6 h by almost 3-fold until day 7 (P<0.01), F (and also B) fluctuated considerably resembling a damped oscillation and, by day 7, reached mean levels less than half of those seen in later childhood. After betamethasone treatment of the mother, neonatal levels of Aldo and F were suppressed to 24–69% of normal until day 9, whereas those of the other steroids (except E) returned to normal during the first hours of life. Phenobarbital (PB) therapy of the mother led to decreased steroid levels in maternal and umbilical venous plasma at term, while umbilical arterial CS levels, notably those of Aldo and F (P<0.02), were increased when compared with untreated controls, indicating a stimulation of the most potent CS in the fetus after PB. The significance of the findings in view of fetoplacental function and fetal organ maturation is briefly discussed.

Lactobezoar in an infant: an unusual cause of upper abdominal tumour persisting for several weeks

A case of lactobezoar is described in an eleven weeks old infant with a history of prolonged vomiting and constipation. The feeding history revealed no abnormalities, but unusually high environmental temperatures plus increased sweating may have been responsible for the formation of the gastric milk coagulum which presented as a firm epigastric tumour persisting for several weeks. An abdominal neuroblastoma was suspected but the correct diagnosis was established by a barium meal. Conservative therapy with parenteral fluids and gentle gastric lavage resulted in prompt disintegration of the lactobezoar. The 9 previously reported cases in the literature are briefly discussed.