Clinical manifestation of adrenocorticotropin-determined plasma concentrations of mineralocorticoid hormones.

Chronic oversecretion of adrenocorticotropin (ACTH) in Cushing's disease and partial adrenal insufficiency results in a plasma pattern of mineralocorticoid hormones (MCHs) in which deoxycorticosterone, 18-hydroxycorticosterone and aldosterone remain within normal limits. In patients with deficiencies of 17 alpha- and 21-hydroxylation, the entire MCH pathway may be initially stimulated by ACTH alone in the presence of reduced cortisol production. An ACTH-induced intra-adrenal factor reflected by levels of cortisol production, or cortisol itself, may determine MCH levels by its inhibition (high) or lack of inhibition (low) of 11 beta- and 18-hydroxylation.