J.Jpn. Surg. Soc.. 61(7): 994-1008, 1960

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Original article

Study on the Adrenocortical Response to ACTH in Surgical Patiens

Adrenocortical response to ACTH was investigated on 49 surgical patients. Circurating eosinophils and plasma levels of free 17-hydtoxycorticosteroids (OHCS) in peripheral blood were determind by means of Silber-Porter method before and 3, 6, 9 hours after 6-hour intravenous infusion of ACTH 25 I.U. at 8 O'clock in 39 cases. A comparative evaluation was also carried out following single intramuscular administration of ACTH 25 I.U., Zn-ACTH 40 I.U. and intracutaneous administration of 0.3 mg of adrenaline in 10 cases. Results are as follow:
1) Control plasma levels of 17-OHCS showed within the range of normal subject which has been presented by the author except cases with liver failure or hyperthyroidism.
Single determination of plasma levels of 17-OHCS, therefore, is inadequate, to evaluate adrenocortical capacity.
2) It should be evaluated by response to either exogenous ACTH.
Adrenaline does not elevate 17-OHCS, so that it is unreasonable to use it in place of ACTH to evaluate adrenocortical capacity.
3) Elevation of plasma levels of 17-OHCS following single intramuscular administration of ACTH is not only slight and transient but also dependent on individual varieties as compared with following ACTH infusion.
Hence, the way of intramuscular administration is unsatisfactory in quantitalive evaluation of adrenocortical capacity. However, the response to intramuscular administration of Zn. ACTH 40 I.U. is continuous over several hours and is almost eqval to the response to infusion of 25 I.U. of ordinary ACTH.
4) Six-hour infusion of ACTH 25 I.U. is excellent and essential for testing adrenocortical capacity. By this method plasma levels of 17-OHCS in surgical patients excluding those with lever failure revealed maximal elevation at the end of the infusion.
This elevation is considered to be a good quantitative indicator of adrenocortical capacity.
5) Thirty-nine cases were divided into three groups from their response in plasma 17-OHCS to standard 6-hour ACTH infusion. 22 cases in which their increment in plasma levels of 17-OHCS at the end of ACTH infusion exceed more than 20 μg per 100ml, followed favorable clinical course even after major surgery. 11 cases in which the increment does not reach to 20μg per 100ml, showed unfavorable prognosis with a death clue to surgery. 6 cases with liver failure demonstrated indefinite response.
6) In cases with sufficient adrenocortical capacity, fall in circulating eosinophils was over 85 per cent in 6-9 hours. However, in cases with insufficient adrenocortical capacity, no particular correlation was noticed between the elevation of plasma levels of 17-OHCS and the fall in eosinophils. Hence, it is unreasonable to evaluate adrenocortical capacity from change in eosinophil counts.
(Author's abstract)

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