Uropepsin and 17-hydroxycorticoid excretion in normal subjects and patients with peptic ulcer during both states of activity and quiescence

Abstract Twenty-four-hour uropepsin determinations were made in normal subjects, and patients with gastric ulcer, active and inactive duodenal ulcer, and steroid ulcers; in all, ninety-one determinations in seventy subjects. In addition, the twenty-four-hour urinary excretion of 17-hydroxycorticoids was determined in forty-eight of the patients. Significant differences were found in the uropepsin excretion in the groups of patients with gastric ulcer and inactive duodenal ulcer when compared to the normal group. However, the standard deviation of the results within the groups was so large that any attempt at delineation of normal and abnormal ranges would be of minimal value. There was no significant difference between uropepsin values in patients with active duodenal ulcer and in normal subjects. In addition, there was no significant difference between uropepsin values in patients with duodenal ulcer during periods of activity of their disease and intervals of well-being. The 17-hydroxycorticoid excretion remained within normal limits in patients with active and inactive ulcer, and in those in whom steroid ulcers had developed. A positive correlation of uropepsin and 17-hydroxycorticoids was obtained only in a small group of patients either with Cushing's syndrome or under treatment with ACTH; i.e., uropepsin values were consistently elevated when there was increased 17-hydroxycorticoid output. This study demonstrated: (1) either that urinary uropepsin does not accurately reflect gastric secretory activity or that the intensity of gastric secretory activity bears no relationship to activation of duodenal ulcer; (2) that there is no evidence for increased adrenocortical activity in patients with idiopathic duodenal ulcer, particularly during periods of activation; and (3) that when adrenocortical hyperactivity, as reflected by urinary 17-hydroxycorticoid excretion does exist, urinary uropepsin is predictably elevated.