ADRENAL CORTICAL METABOLISM IN CHRONIC LIVER DISEASE

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Abstract
Adrenal cortical function was studied in 3 groups of patients with hepatic cirrhosis: (1) Laennec''s cirrhosis, (2) primary biliary cirrhosis with xanthomatosis, and (3) an undetermined cirrhosis occurring in young females. Depressed daily excretion of 17-ketosteroids and elevated "corticoids" in chronic hepatic disease indicate that there are disturbances in the metabolism of adrenal cortical hormones. Diminution in the proportion of ketosteroids excreted as glucuronidates in hepatic cirrhosis of all types implies interference with their disposal as water-soluble metabolites. The low alpha-ketosteroids are primarily responsible for the decreased total quantity. Testosterone propionate provoked a moderate rise in excretion of 17-ketosteroids in cirrhosis. Ketosteroid excretion varied directly with urine volume. The concns. of Na in urine, saliva and sweat are markedly reduced in cirrhosis with fluid retention. The elevated urinary corticoids in Laennec''s cirrhosis may be related to desoxy-corticosterone-like hormones. A further rise in chemically determined corticoids was observed after Na restriction. Attention is called to a group of young females with chronic hepatic disease of unknown etiology, having clinical features of hyperadrenalism early in the course of their disease. Most characteristic is the elevation of serum gamma globulin and total protein. Urinary corticoids are high in these patients and biologic tests indicate increased glycogen storage activity. ACTH caused marked elevation of fasting blood glucose in 3 of 7 patients and may be related to failure of hepatic glycogen storage. No significant benefit was seen in patients with Laennec''s cirrhosis. The major complication encountered in the course of therapy with ACTH was portal thrombosis which occurred in 3 patients. Temporary beneficial effects consisting of a fall in serum bilirubin, a rise in serum albumin, and a fall in serum gamma globulin were observed in the group of young females with cirrhosis of unknown etiology who received ACTH therapy.