Clinical Studies on the Excretion of Cortico-Steroids in the Various Surgical Diseases and Surgical Manipulations

Abstract

It is of interest to study the activity of pituitary adrenocortical function in patients with various surgical diseases and surgical manipulations. The urinary excretion of corticosteroids (C-S) was determined to authenticate the function of these systems. Simultaneously, the immediate response upon urinary excretion of C-S to ACTH was compared with those after surgical operations in the same patients.The results were as follows:(1) Each 24 hours urine sample was collected, and the amount of urinary excretion of C-S (measured as formaldehydogenic steroids) was determined in 77 surgical patients-(carcinoma 23 cases, surgical liver diseases 10 cases, surgical abdominal diseases 20 cases, and endocrine diseases 24 cases).Each group of surgical disease excreted higher amount of urinary C-S than the normal subjects, and the highest value was found in patients with carcinoma while those with gastric ulcer were below the control level. This fact may be applicable clinically as a diagnostic aid for the diagnosis of carcinoma and ulcer of stomach.(2) The amount of daily excretion of C-S after operation showed daily fiuctuations. One or two elevations (peak) of urinary excretion were seen during the 2 weeks after operation. Among 32 cases of operation, 23 cases showed 2 Peaks and in the remaining 9 cases were 1 peak. The first peak was higher than the second peak in many cases.(3) The immediate responses upon the urinary excretion of C-S to ACTH were measured in 18 surgical patients, and in average a 3 fold increase in C-S excretion were found in these patients with ACTH injection. It has also been found that the responses to ACTH and to operative manipulation upon urinary excretion of C-S were almost the same when the average increased amounts of urinary excretion were compared in both cases.(4) The effects of ACTH on blood sugar values of 21 surgical patients were tested. Hypoglycemic effects have been seen in 13 cases, while 2 cases were followed by elevation of blood sugar, and 6 cases responded with both hyper and hypoglycemic phase. Therefore, ACTH was suggested to induce the decreased effects of blood sugar to many of surgical patients. However, no correlation between the urinary C-S excretion and the change of blood sugar value was found to exist following ACTH injection.