The effects of long-term alternate-day steroids on parameters of adrenal function in renal transplant patients

Urinary androgen fractions, with other parameters of adrenal function, were assessed in renal transplant patients on long-term alternate-day steroid therapy. Urinary 17-ketosteroids and plasma cortisol values were low normal or slightly reduced in female patients and normal in male patients. In female patients the following urinary androgen fractions were depressed to less than the normal range: androsterone, dehydroepiandrosterone, etiocholanolone and 11-ketoetiocholanolone; 11-hydroxyetiocholanolone was not detectable. In male patients dehydroepiandrosterone and 11-ketoetiocholanolone were depressed to less than the normal range. Adrenal scan using 131I-19-cholesterol failed to image the adrenal glands in 5 of 7 patients studied, confirming the lack of an adrenocorticotropic hormone effect, with corresponding depression of the hypothalamic-pituitary-adrenal axis. These studies demonstrate the value of fractionating urinary 17-ketosteroids in assessing adrenal reserve and are a more sensitive index of adrenal suppression than the total 17-ketosteroids alone.