Excretion and anticonvulsant activity of steroid hormones in an infant with infantile spasm and hypsarrhytmia treated with excessive doses of ACTH

The excretion of steroids in urine and faeces was studied in an infant with infantile spasm with hypsarrhytmia. The analyses, which were carried out by gas-liquid chromatography and gas chromatography-mass spectrometry, were done before and after the infant was treated with excessive doses of ACTH. Prior to treatment the infant excreted less than 0.1 mg/24 h of individual steroids but after treatment the concentration in urine and faeces of several steroids increased 20-30 fold and the total excretion was about 12 mg/24 h both in urine and faeces. All the quantitatively predominant steroids excreted after ACTH treatment had a 3β-hydroxy-5-ene-structure: 3β,16α-dihydroxy-5-androsten-17-one, 3β,17β-dihydroxy-5-androsten-16-one, 5-pregnene-3β,20α-diol, 3β,16α-dihydroxy-5-pregnen-20-one, 3ξ,20ξ-dihydroxy-5-pregnen-16-one and 5-pregnene-3β,17α,20α-triol. 5-Pregnene-3β,20α-diol had an anticonvulsant activity when tested on newborn mice and the hypothesis is presented that the antiepileptic effects of ACTH in infants with hypsarrhytmia may be mediated via 3β-hydroxy-5-ene-steroids.