Hormones and the Kidney: Possible Therapeutic Role of Testosterone in a Patient with Regression of Metastases from Renal Adenocarcinoma

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Abstract
Attention is directed to the many endocrine factors, including gonadal hormones, which influence renal structure and function, and to the possible role of the kidney itself as an endocrine organ. Reference is made to renal cortical tumors which can be induced in male hamsters by prolonged estrogen treatment and prevented by the simultaneous administration of testosterone or progesterone. Sex is an important factor in cancer of the human kidney. The disease occurs twice as often in men as in women, and spontaneous regression is seen predominantly in males. A man aged 58 whose general condition was deteriorating with skeletal and intrathoracic metastases after nephrec-tomy for renal carcinoma was treated with hormones. Tumor growth appeared to be accelerated during the administration of a progestational agent, Provera (medroxyprogesterone acetate; 6[alpha]-methyl-17[alpha]-hydroxyprogesterone acetate). With a change to testosterone propionate there was rapid improvement in general health with subsequent regression of metastases for almost 3 years. Death occurred with widespread soft-tissue depoists, the skeletal lesions remaining radiologically healed. Histological examination of a previous large osteolytic deposit in the skull showed no residual tumour. The case described here is one of 4 cases showing wellmarked objective signs of tumor regression in a consecutive series of 20 patients with progressive metastatic renal cancer treated with hormones: the 3 other patients received Provera. Reasons are given for suggesting that the regression of metastases observed in these cases may be the result of hormone treatment. Attention has been given to the subject of spontaneous regression of renal cancer. At this stage it is impossible to rule out this phenomenon as the explanation for the observed response in the hormone-treated cases, but, if so, the incidence of natural regression in this disease must be greater than is at present generally appreciated.