The metabolic response to adrenalectomy and hypophysectomy

Abstract

1. 1. Observations have been made upon the balance of sodium, potassium, chloride and nitrogen and the excretion of corticosteroids in the urine in three patients subjected to bilateral adrenalectomy and given constant doses of cortisone acetate, and in two patients undergoing hypophysectomy, only one of whom received cortisone acetate. 2. 2. The usual post-operative metabolic changes of sodium and chloride retention with loss of potassium and nitrogen in the urine occurred in all patients. In the three patients subjected to second stage adrenalectomy, the metabolic response was not associated with a rise in the urinary excretion of adrenocorticosteroids (acid-stable formaldehydogenic or 17-hydroxy-steroids). Increase in urinary corticosteroids occurred in both patients after hypophysectomy and in the one patient studied on whom a first stage adrenalectomy was performed. 3. 3. It is concluded that the metabolic responses observed after second stage adrenalectomy occurred in the absence of significant alterations in the rate of adrenocortical secretion. The observations we have made do not eliminate the possibility that trauma and surgical operation in patients with intact adrenal glands increase the secretory activity of the adrenal cortex. However the occurrence of alterations in electrolyte and nitrogen balance following surgical trauma may not be used as evidence that such an increase in secretion occurs. 4. 4. The role of the cortisone acetate given to the patients before and after removal of the adrenal glands in the metabolic response is discussed. Although the results are not inconsistent with the “permissive” action of the hormone as suggested by Ingle, the possibility that alterations in metabolism and the rate of excretion of the hormone result in an increase in the blood concentration of biologically effective hormone with consequent alterations in electrolyte and nitrogen balance cannot be excluded. Nevertheless, if such an alteration in the rate of disposal of biologically active hormone occurs for some days after the operation, it must do so without causing a rise in the urinary content of the measured steroid métabolites such as is normally found after operations not involving the adrenal glands. 5. 5. Four possible interpretations of the increase in corticosteroids in the urine after hypophysectomy are suggested but it is not possible to decide which of these explanations is correct.