Within 24 hours more than 78% of the intravenously injected radioiodine is excreted in urine by hypothyroid patients and less than 65% by hyperthyroid patients.
The patients with nephrotic syndrome reveals a decreased urinary excretion of radioiodine and an elevated proteinbound iodine content in plasma. These findings, however, depend rather on a disturbed excretory function of the kidney than thyroid function. After parenteral:administration of radioiodine the proteinbound radioiodine is excreted in the urine of nephrotic patients, the content of which is correlated significantly with the 3α-globulin content in plasma.
Most of our diabetic patients have an elevated basal metalolic rate. The correlation of which with the blood sugar level is not observed significantly. But the diabetics with hyperglycemia more than 200mg/dl or polyuria more than 3lit/day reveal similar findings to those of hyperthyroid patients.

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The Cushing's syndrome has following symptomes, they are excess of fat which appears especially on trunk, face and neck, full moon face, hypertension, hypertrichosis, striae cutis disensae, suger metabolism disturbance, osteoporosis, myasthenia, decubitus ulcer, and in female case, menoxenia.
We recently had female & male cases which considered to be cushihg's syndrome.
1) The female case; 45 years old unmarried school teacher complaind of abnormal fat excess of neck & trunk and palpitation. Through out her physical investigations, we got followng data, they are, excess of fat on neck & trunk, full moon face, hypertension, hypertrichosis, striae cutis distensae, desubitus ulcer, decrease of lymphocyte & eosinophilic leukocyte, plethora, increase of serum K & Cl and menoxenia. We couldn't prove increase of 17 OHCS & 17 KS in urine and osteoporosis.
2) The male case; 48 years old man, has no hereditary disease and past anamnesis, complaind of slight headache, languourous legs & concequently, dysbasia. Objective view of this patient are as following, fatty obesity, full moon face, hypertension, plethora, suger metabolism disturbance, slight hyperglycemia, myasthenia and decrementum of sexual impuls. And we also couldn't prove osteoporosis, hypertrichosis and striae cutis distensae.

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The patient was a female, 60 years of age, who had suffered from the pulsating pain in the occipital region 20 days prior to the admission. Her physical condition became progressively worse in association with vomiting, diplopia, incontinentia and unconsciousness. The clinical impression was at first encephalitis japonica or meningitis. Routine laboratory studies revealed the hypochromic anemia and leucocytosis with neutrophilia. Serologic tests for syphilis were positive in blood and negative in liquor. The blood pressure was 100/60. The cerebrospinal fluid was hemorrhagic with the positive globulin reactions. During the course of hospitalization, the patient remained somnolent and died suddenly 43 days after the onset of symptoms. Thus the intracranial tumor was suspected.
II. Autopsy findings i) Macroscopic findings.
Both adrenals were diffusely enlarged. (left: measuring 7 by 4.5 by 2.4 cm, weighing 40g right: 8.5 by 6.0 by 2.4 cm, 72g). The adrenal medullae were completely replaced by the tumor tissue,which converted the adrenal cortex to be a paper-thin capsule. At one end of the left tumor, a rim of compressed adrenal cortical tissue was seen. On cut surface, tumor tissue was fragile, showed neither softening nor cyst formation. Ground color of the tumor was grayish-white, mottled by the points of red hemorrhages and yellow coagulation necrosis.
Metastasis of the tumor was observed in the cerebellum (both hemisphere), colon (40cm anal from ileocoecal region), all lymph nodes but mesenteric nodes.
ii) Microscopic findings.
The neoplasm was composed of cells which varied greatly in size and shape and were arranged for the most part diffusely without assuming any regular pattern. There were also alveolar structure,rosette formation, palisade and pseudofollicular arrangement in some areas. In general cell boundaries were indistinct. Some of the cells underwent hydropic change. Numerous mitotic figures were encountered throughout the section. The occurrence of multinucleated cells and large syncytial cells were characteristic in the tumor. There was a moderate amount of necrosis and hemorrhage. The tumor cells were demonstrated to contain no fat and P.A.S. positive granules. A portion of the tumors was placed in Orth's solution in order to demonstrate the possible chromaffinity of the cells.But the result was negative. The staining of the formalin-fixed tissue with azocarmine, as recommended by Gomori, gave also negative result.
The brown coarse granules, negative for iron reaction and not bleached by hydrogen peroxide, were observed in the peripheral portion of the tumor, to which great attention had been drawn by Dietrich and Siegmund as characteristic to pheochromocytoma. It was most interesting for us that the droplets ranging in size from nucleolus to nucleus were stained reddish, yellowish by azan-staining, which were first described by Oberndorfer (1909) to appear under the infectious condition in adrenal medullary cells.
These droplets can be stained with high specificity by the carbol fuchsin. The occurrence of Oberndorfer's droplets are strongly suggestive of the origin of the tumors from the adrenal medullary cells in spite of negative chromaffin reaction.

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The function of the adrenal cortex has been studied in patients with chronic cardiac failure, and it was found that the secretory activity of the adrenal cortex showed a marked fall, and plasma levels and urinary excretion of corticoids showed significant decreases in these patients in comparison with normal subjects. Especially, in serious cases, it was characterized that the value of the conjugated form of the corticoids in both blood and urine were extremely low.
Also in patients with chronic cardiac failure, it was observed that the functional and histological changes in the liver were parallel with the grade of cardiac failure.
The fate of the orally administered hydrocortisone has been studied in patients with cardiac failure. The disappearance of hydrocortisone from blood was slower in these patients than in normal subjects, and also its urinary excretion extremely delayed in proportion to the grade of the hepatic dysfunction.
To confine the above mentioned experiments, thoracic inferior vena cava constriction was produced in the dogs. The functional disturbance of the liver was found in one to two weeks after the constriction and was at its maximum in three to four weeks; on the other hand, the fibrosis was found in every zone of the adrenal cortex, indistinct nuclei and fatty degeneration without blood congestion, in three to four weeks.
In these experimental dogs, the author observed the disturbance of corticoid metabolism, such as the delayed disappearance of the intravenously infused hydrocortisone from blood and the reduced difference of the plasma 17-OHC. S. level between the femoral artery and the hepatic vein.
The plasma level of 17-OHC. S. gradually elevated after the vein constriction and reached at its maximum in two weeks. In the stadium which showed the functional and histological changes in the liver, the adrenal cortex showed normal finding. Then, the plasma level of 17-OHC. S., distinctly fell in three to four weeks, namely in the stadium which showed the fibrosis of the adrenal cortex.
From these facts, it was suggested that the high plasma level of free 17-OHC. S. in one to two weeks, was produced by the metabolic disturbance of the corticoid due to hepatic dysfunction.
It will be discussed that as the results of the inhibition of the ACTH secretion due to the continuance of the high plasma level of free 17-OHC. S., the dysfunction of the adrenal cortex was caused.

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It is well known that the endocrine imbalance in diabetes mellitus causes metabolic disturbances not only of carbohydrate, but also of protein and lipids. However, in the treatment of diabetic patients, the importance of hyperglycemia and glycosuria as therapeutic guide has been too much emphasized, so that other metabolic abnormalities have often been neglected.
In order to control these patients more satisfactorily, the metabolism of α-keto acids and the activity to acetylate para-aminobenzoic acid (PABA) were studied in patients with diabetes mellitus before, during and after various types of treatment. These results were also compared with those in alloxanized animals.
The therapeutic significance of these metabolic abnormalities were also discussed.
Metabolism of α-keto acids in patients with diabetes mellitus.
1) The ratio of the increase of urinary pyruvate and α-ketoglutarate in the 1st resp. 2nd hour following fructose administration to that in the fasting state was significantly higher in diabetics than in normals.
2) These abnormalities were more marked in cases complicated with hypertension or arteriosclerosis than in those without these complications.
3) Positive correlation was found between fasting blood sugar level and the ratio of urinary α-keto acids in the 2nd hour following fructose administration.

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1) The average acetylating activity of 62 cases with diabetes mellitus was 74.61±10.3% in contrast to 89.6±2.8% in normal adults.
2) Negative correlation was found between the acetylating activity and fasting blood sugar level.
3) The acetylation was found markedly decreased in juvenile patients and those with abnormal body weight.
4) Marked decrease of acetylation was found in cases complicated with hypertension or arteriosclerosis.

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