- Email: [email protected]
26. Dysfunction of the adrenal cortex in cancer patients
466
Southern Society for Clinical Research
effect. Mild toxic reactions were observed with caronamide levels exceeding 40 mg. per cent. 26.
DYSFUNCTION OF THE ADRENAL
CORTEX
IN CANCER PATIENTS EDWARD C. REIFENSTEIN, JR., M.D., F. HOMBURGER, M.D. and KONRAD DOBRINER, M.D. (introduced by Albert Segalofft M.D.) From the Departmentsof Clinical Investigationand Steroid Chemistry, the Sloan-Kettering Institute for Cancer Research, the Memorial Cancer Center, New York, N. Y.
Evidence will be presented which suggests that patients with cancer have dysfunction of the adrenal cortex. This evidence includes: (1) the nature of certain urinary steriod metabolites; (2) a comparison of the urinary steriod metabolites of cancer patients with those of patients with known disorders of the adrenal cortex; (3) a comparison of the “alarm reaction” following operation in patients with and without cancer; (4) the effect of adrenal cortical extract on the low liver glycogen content of patients with gastric cancer; (5) a comparison of electrolyte defects of patients with gastric cancer with those of patients with Addison’s Disease and (6) a comparison of the adrenal cortical pituitary adrenocorticoresponse to anterior trophic hormone of patients with gastric cancer with those of patients with non-neoplastic non-adrenal diseases. The significance of these results will be discussed. 27. DAILY VARIABILITY OF THE FLUID RESTRICTION AND PITRESSIN CONCENTRATION TESTS FOR RENAL FUNCTION J. MAXWELL LITTLE, M.D. and GEORGE A. ANDERSON,M.D. (introduced by Harold D. Green, M.D.) From the Department of Physiology and Pharmacology and Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, N. C.
Interpretation and comparison of the twelve hour Auid restriction and pitressin (10 units subcutaneously) concentration tests for renal function assumes that the daily variability in each is insignificant. This was tested in a random group of students, twenty-five (average six tests) with fluid restrictions and ten (average five tests) with pitressin. The average o for the former was 2.9 and for the latter 3.8 units. There was no correlation
between the individual mean values of specific gravity and o. Interpreting specific gravities below 1.020 as impaired renal function, the results on the first fluid restriction and pitressin tests compared with subsequent tests were, respectively consistently good function 12, 2; consistently impaired function 2, 1; varying between good and impaired function 9,4; between impaired and good 2, 3 patients. Interpreting specific gravities of 1.027 or greater as good, 1.014 to 1.027 doubtful, and below 1.014 impaired function, the respective results were: consistently good function 4,0; consistently doubtful 10,5; consistently impaired 0.0; varying from doubtful to good 8,3; poor to doubtful 2,2; poor to good l,O. The pitressin test is more variable than the fluid restriction test. Because of daily variability, a single test of either type is of little value if the result indicates impaired or doubtful function. 28.
EFFECT OF THE ADRENAL CORTEX ON DIABETES DURING INFECTIONS
LOUISTOBIAN,JR., M.D. andJAcK EDWARDS,M.D. (introduced by Morton F. Mason, M.D.) From
the Department of Pathological Chemistry, Southwestern Medical College, Dallas, Texas
The hypersecretion of the adrenal cortex caused by infections and the inhibition by adrenal cortical extracts of the hexokinase reaction of the diabetic muscle suggested that infections produced an exacerbation of diabetes by causing increased adrenal cortical secretion. To study this, we divided a number of mice made diabetic with alloxan into two groups. One group had intact adrenals; the other group was adrenalectomized and then continuously given .05 cc. of Upjohn’s lipo-adrenal cortex every eleven hours. Both groups received three injections of typhoid vaccine, one every eight hours, and fasting blood sugars were obtained before and after the course of typhoid injections. The, adrenalectomized animals receiving adrenal cortex hormone showed as great a rise in blood sugar level after the typhoid vaccine as the animals with intact adrenals. Hence, an increased secretion of adrenal cortex hormone after typhoid is not responsible for the exacerbation of the diabetes. AMER,CAN
JOURNAL
OF
MEDICINE
Southern Society for Clinical Research
effect. Mild toxic reactions were observed with caronamide levels exceeding 40 mg. per cent. 26.
DYSFUNCTION OF THE ADRENAL
CORTEX
IN CANCER PATIENTS EDWARD C. REIFENSTEIN, JR., M.D., F. HOMBURGER, M.D. and KONRAD DOBRINER, M.D. (introduced by Albert Segalofft M.D.) From the Departmentsof Clinical Investigationand Steroid Chemistry, the Sloan-Kettering Institute for Cancer Research, the Memorial Cancer Center, New York, N. Y.
Evidence will be presented which suggests that patients with cancer have dysfunction of the adrenal cortex. This evidence includes: (1) the nature of certain urinary steriod metabolites; (2) a comparison of the urinary steriod metabolites of cancer patients with those of patients with known disorders of the adrenal cortex; (3) a comparison of the “alarm reaction” following operation in patients with and without cancer; (4) the effect of adrenal cortical extract on the low liver glycogen content of patients with gastric cancer; (5) a comparison of electrolyte defects of patients with gastric cancer with those of patients with Addison’s Disease and (6) a comparison of the adrenal cortical pituitary adrenocorticoresponse to anterior trophic hormone of patients with gastric cancer with those of patients with non-neoplastic non-adrenal diseases. The significance of these results will be discussed. 27. DAILY VARIABILITY OF THE FLUID RESTRICTION AND PITRESSIN CONCENTRATION TESTS FOR RENAL FUNCTION J. MAXWELL LITTLE, M.D. and GEORGE A. ANDERSON,M.D. (introduced by Harold D. Green, M.D.) From the Department of Physiology and Pharmacology and Department of Internal Medicine, Bowman Gray School of Medicine, Winston-Salem, N. C.
Interpretation and comparison of the twelve hour Auid restriction and pitressin (10 units subcutaneously) concentration tests for renal function assumes that the daily variability in each is insignificant. This was tested in a random group of students, twenty-five (average six tests) with fluid restrictions and ten (average five tests) with pitressin. The average o for the former was 2.9 and for the latter 3.8 units. There was no correlation
between the individual mean values of specific gravity and o. Interpreting specific gravities below 1.020 as impaired renal function, the results on the first fluid restriction and pitressin tests compared with subsequent tests were, respectively consistently good function 12, 2; consistently impaired function 2, 1; varying between good and impaired function 9,4; between impaired and good 2, 3 patients. Interpreting specific gravities of 1.027 or greater as good, 1.014 to 1.027 doubtful, and below 1.014 impaired function, the respective results were: consistently good function 4,0; consistently doubtful 10,5; consistently impaired 0.0; varying from doubtful to good 8,3; poor to doubtful 2,2; poor to good l,O. The pitressin test is more variable than the fluid restriction test. Because of daily variability, a single test of either type is of little value if the result indicates impaired or doubtful function. 28.
EFFECT OF THE ADRENAL CORTEX ON DIABETES DURING INFECTIONS
LOUISTOBIAN,JR., M.D. andJAcK EDWARDS,M.D. (introduced by Morton F. Mason, M.D.) From
the Department of Pathological Chemistry, Southwestern Medical College, Dallas, Texas
The hypersecretion of the adrenal cortex caused by infections and the inhibition by adrenal cortical extracts of the hexokinase reaction of the diabetic muscle suggested that infections produced an exacerbation of diabetes by causing increased adrenal cortical secretion. To study this, we divided a number of mice made diabetic with alloxan into two groups. One group had intact adrenals; the other group was adrenalectomized and then continuously given .05 cc. of Upjohn’s lipo-adrenal cortex every eleven hours. Both groups received three injections of typhoid vaccine, one every eight hours, and fasting blood sugars were obtained before and after the course of typhoid injections. The, adrenalectomized animals receiving adrenal cortex hormone showed as great a rise in blood sugar level after the typhoid vaccine as the animals with intact adrenals. Hence, an increased secretion of adrenal cortex hormone after typhoid is not responsible for the exacerbation of the diabetes. AMER,CAN
JOURNAL
OF
MEDICINE