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The ratio, proposed by Hill (1960) (now called the 11-oxygenation index) of the urinary metabolites of cortisol precursors to those of cortisol, has been studied in detail. The index was determined in forty-eight adults and children without endocrine disorders. The mean was 0·32 ± 0·19 (S.D.). One abnormal value (1·3) was obtained from a child found to have normal adrenals at examination post mortem.

Ten patients with adrenal hyperplasia gave values of the index ranging from 1·1 to 8·4.

The procedure for determining the index involved borohydride reduction, periodate oxidation, formylation, paper chromatographic separation and a simplified Zimmermann reaction. Analysis of a batch of urine samples took less than 6 hr. to complete.

The merits of this method and those of the other laboratory tests used in the diagnosis of adrenal hyperplasia are discussed.