Increased Urinary Estrogen Excretion Associated With Adrenal Tumors: Report of Four Cases*

The determinations of urinary hormone excretion were made by the routine clinical methods used in our laboratory. Steroids other than corticoids were extracted with carbon tetrachloride after acid hydrolysis. The technic for total neutral 17-ketosteroids was a modification of that described by HoltorfT and Koch (1). Dehydroisoandrosterone was determined by the method of Allen, Hayward, and Pinto (2). In the 2 patients with increased neutral 17-ketosteroid excretions, the phenolic fraction obtained by extraction with IN KOH was separated from the carbon tetrachloride extract and was used for bioassay of estrogens. This technic separates the true estrogens from the androgens and is necessary, since dehydroisoandrosterone and certain other androgens have been shown to have a vaginal cornifying effect (3). Bioassay for estrogens was performed at selected levels in castrated mice, using the vaginal smear technic. Corticoids were determined by a modification of the technic described by Heard, Sobel and Venning (4), and involved extraction with chloroform from acidified urine for one hour with an automatic shaker. Gonadotropins