ENDOCRINOLOGICAL STUDY ON PROSTATIC CARCINOMA

EFFECTS OF ANTI-ANDROGENIC TREATMENT ON PITUITARY ACTH RESERVE FUNCTION

Abstract

(1) Both ACTH and Metopirone tests were performed on twelve patients with prostatic carcinoma before and after several kinds of endocrinologic treatments, in order to investigate the changes in pituitary-adrenal functions. Urinary 17-OHCS (Porter-Silber chromogens) was measured in succession before and after ACTH and Metropirone administrations. The treatments consisted of castration, estrogen administration and pituitary irradiation.
(2) Pre-treatment levels of urinary 17-OHCS in the patients of postatic carcinoma did not differ from those of controls of same age. And there was no abnormality in the results of ACTH and Metpirone test before any treatments.
(3) Ten to twelve days after castration, urinary 17-OHCS levels showed a slight, but insignificant elevation. The results of ACTH and Metopirone tests showed no significant difference from the pre-treatment values.
(4) Estrogen administration resulted in reduction of urinary 17-OHCS, which was restored to the pre-treatment levels as soon as estrogens were withdrawn. A marked reduction in pituitary ACTH reserve was observed during estrogen administration, while the results of ACTH tests did not show any changes. Though the changes of Metopirone tests were marked during estrogen therapy, they returned soon to the pre-treatment values with the withdrawal of estrogen, even if after administration of a longer period.
(5) After pituitary irradiation of 4, 000 to 7, 500r (surface doses) the urinary 17-OHCS levels remained within the control values. The results of ACTH and Metpirone tests showed on abnormality following irradiation of 4, 000 to 6, 000r, but a patient who had received 7, 500r irradiation showed a moderate reduction of pituitary ACTH reserve.
(6) Reduction in pituitary ACTH reserve during estrogen administration indicated the possibility that estrogen administration might suppress the pituitary function as inhibiting ACTH secretion in some degree, because the results of ACTH tests showed no changes. It is suggested that the effectiveness of estrogens on postatic carcinoma might be explained not only by antagonistic action against androgens and suppressive action of gonadotropin secretion, but also by suppression of adrenal androgen-secretion due to ACTH inhibition. Estrogen administration should be continued as long as hormone dependency of the carcinoma was maintained. It was also verified that estrogen administration did not supperess adrenal function.
(7) In cases of pituitary irradiation no replacement of corticoides was required provided that the doses remained within 6, 000r. In cases of irradiation more than 7, 500r, replacement therapy of corticosteroids should be instituted of Metopirone test, which was one of reasonable indicators of the pituitary functions, showed a reduction of pituitary ACTH reserve.