尿路腫瘍とホルモン環境 II:下垂体副腎皮質と尿路腫瘍

Abstract

The activity of the pituitary-adrenocortical system of the patients with various genitourinary tumors was studied by measuring urinary gonadotropin and 17-KS excretion. A. Urinary Gonadotropin (1) Determ i nation of urinary excretion of gonadotropin was carried out by assay with use of immature female mice of D D strai, n. Protein material containing the hormone was precipitated by the addition of 40 cc alcohol, and the simple kaolin absorption was apllied to remove the protein. (2) Norma l excretion of twelve males over 50 years was 15 to 148 mouse units per twenty-four hours. If an extreme case excluded, it was 15 to 74 units, average being 47 units. In six postmenopauseal females, it showed rather higher level with broad range of 92 to 499 units. (3) F o rty-two patients with tumor of the prostate showed the excretion within normal limits. In carcinoma of the prostate, it was below 40 units in all cases, being 39 units in average. This level was obviously lower than that seen in the patients with benign prostatic hypertrophy showing the excretion of 56 units in average. It was observed, as in other kinds of tumors, that th e prognosis of prostatic carcinoma was rather poor in the cases whose urinary gonadotropin excretion was low, on the other hand, rather favorable in the cases with high excretion. (4) In renal tumor, gonadotropin excretio n seemed to be a little diminished . Two of three cases of testicular tumors showed excessive excretion . No significant trend was recognized in other tumors. (5) Under the ad m inistration of estrogen or androgen, there was suppression of gonadotropin excretion. Androgen acted less remakably than estrogen . Castration usually increased its excretion. No specific response was, however, observed in individual tumor . (6) Under the administration of ACTH-Z 2 5 m g., gonadotropin excretion di m inished to various extent, being more remarkable in benign prostatic hypertrophy than in carcinoma of the prostate, some of which showed even the increased excretion . Continued administra Lion of cortisone brought an increase of gonadotropin excretion in one week and lowered it in four weeks in a few cases. (7) Chemotherapeutics for tumor brought the decrease of urinary gonadotropin excretion, whereas goCo irradiation increased it in one of two cases. IL Total Urinary 17-Ketosteroid (1) Urinary 17-K S was determined by Drekter's method modified by Drs. Okinaka and Nishikawa. (2) Control group, six males of 45 to 82 years of age, showed its excretion to be 4.8 to 14.2 mg. per day, average being 9.9 mg. per day. (3) Of eighteen cases with prostatic tum o r, average daily excretion was 11.1 mg. in carcinoma of the prostate, whereas 10.9 mg. in hypertrophy. There was, therefore, no significant difference observed. (4) No significant increase or decrease was observed in other genitourinary tumors. (5) Castration generally lowered the excretion of total 17-KS to the vario u s extent being not so compatible with clinical manifestations. Estrogen administration also lowered its excretion. (6) Administration of adrenocortical hormone diminished the urinary excretion of total 17-KS in all cases. On the other hand, ACTH-Z raised it in many cases. There was no specific way of respone in each tumor individually. (7) Chemotherapeutics for tumor d i d not give any influence on its excretion. From the studies above and in Report I, it was impressed that there was hypofunction of the hypothalamus-pituitary system and hyperfunction of the adrenal cortex in the patients with carcinoma of the prostate.