Abstract
Pituitary-adrenocortical functions were studied in those patients who had been treated with adrenocortical steroids by means of insulin stress test, rapid ACTH test and ACTH Z (depo-tetracosactide) intramuscular injection test. Particulary, it was investigated in connection with the effects of the total dosage of steroids administered and of patient's age.
In patients received 2000-5000 milligrams of steroids in predonisolone base, the blood cortisol response was subnormal in insulin stress test, and it was markedly decreased in patients receiving over 5000 milligrams, especially in aged patients scarcely any response could be found.
By rapid ACTH test, adrenocortical responsiveness reduced in the old ages already in patients receiving 2000 to 5000 milligrams steroid in predonisolone base. These findings suggested that by increasing the amount of steroids, pituitary-adrenocortical function of old men were apt to be supressed earlier than that of young men, and the patients treated with quantity of predonisolone from 2000-5000 milligrams were situated namely in “transitional stage” to marked pituitary-adrenocortical disfunction.
Urinary 17-OHCS response to first ACTH·Z injection in aged subjects were also lower than that in young men. When the patients had received continuous stimuli by ACTH·Z, most patients responded supernormal in urinary 17-OHCS levels. But the maximum urinary 17-OHCS levels following prolonged large quantity of corticosteroids administration were as half as that of small quantity administration of corticosteroids.
From the investigations in cases treated with both steroid and ACTH·Z, if we want to withdraw patients from steroid by ACTH·Z injection, especially in the patients with prolonged large quantity of steroids, we had better administer ACTH·Z to them about 3 times a week for several months after withdrawal from steroid.
