The inevitable and harmful suppression of hypothalamo-pituitary adrenocortical function results from the corticoid administration. In order to check the iatrogenic adrenocortical dysfunction and to prevent this side effect, the periodical ACTH-Z tests before, during and after treatment for the 13 nephrotic patients were performed.
The adrenocortical function was examined by daily urinary excretion of Porter-Silber chromogen, Zimmermann chromogen and 17-KGS. Functional reserve of hypothalamo-pituitary adrenocortical system was examined by response of intramuscular injection of 25 units of ACTH-Z and then by response to oral administration of 3 gm of SU-4885.
Both the daily urinary excretion of corticosteroids and the response to ACTH-Z in the nephrotic patients before corticoid treatment showed no significant difference from those in normal adults. Poor responses to SU-4885 were observed in four patients before treatment.
There was no correlation between the daily excretion of the response value to ACTH-Z and the results of renal function in the patients.
In the course of treatment with betamethasone, urinary corticosteroid promptly de-creased. However, the response to ACTH-Z was gradually depressed. The mean “adrenocortical response value” in terms of the increments in urinary Porter-Silber chromogen showed the following values : 20.1±10.9 mg before the corticoid treatment, 16.1±7.4 mg in 2 weeks after administration, 10.0±6.9 mg in a month, 7.9±5.9 mg in 2 months, 7.3±5.0 mg in 3 months, 4.6±4.9 mg in 4 months, 12.0±5.1 mg in a week after discontinuing betamethasone and 14.6±7.5 mg a month later. Similar changes in the adrenocortical response value from the increments in Zimmermann chromogen or 17-KGS in urine were observed. However, Porter-Silber chromogen was verified to be the most reliable measurement for tracing the response of adrenal cortex during the betamethasone treatment.
After the dosage of betamethasone tapered at 1.0 mg or less per day, the daily excretion of urinary corticosteroids and the response value to ACTH-Z were gradually elevated.
After discontinuation of corticoid therapy, the recovery of suppressed adrenocortical function was observed in all cases. A rebound phenomenon was observed within a week. The response value to ACTH-Z after discontinuing corticoid therapy also showed improvement but showed no significant difference from the level before treatment of corticoid or from normal range. The response to SU-4885 in only three cases were significantly reduced.
No inverse correlation was observed between the daily corticosteroids excretion, as well as the response value to ACTH-Z after treatment, and the sum of administered doses of betamethasone, or the duration of corticoid therapy. Throughout the course of treatment, there was no case who showed clinical manifestations or laboratory findings indicating adrenocortical insufficiency.
From these observations, it is concluded that the ACTH-Z test before, during and after treatment with betamethasone is a reliable test to evaluate the adrenocortical reserve. The withdrawal adrenocortical insufficiency will be safely avoided in so far as “adrenocortical response value” to ACTH-Z remains within the above-mentioned ranges.
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