140 General Discussion 



when ACTH lirst reared its ugly head, there was considerable clinical 

 opinion that older individuals responded to stresses of various kinds less 

 effectively than the young, and presuming that ACTH represented a 

 physiological stimulus to the adrenal cortex, it was thought that one 

 ought to see differences in response to a physiological stimulus. 



Rubin: I'd like to point out once more that in these old people the 

 11-oxygenated 17-ketosteroids which come from the C21 steroids were 

 not nearly so markedly decreased as those reflecting C19 steroid pro- 

 duction: they were still excreting 50-60 per cent of the young adult 

 level of 17-ketosteroids coming from C21 steroids, though the total 

 17-ketosteroid excretion was down to 30 per cent, reflecting the greater 

 decrease of the non- 11 -oxygenated steroids. I think the physiological 

 tests of metabolic response of which Dr. Shock speaks would be due to 

 the 11-oxygenated C21 steroids, so one would not expect a marked 

 difference in young and old subjects. 



