Plasma cortisol levels in lung cancer

Leukocyte concentrations in discrimination of benign from malignant lung lesions

Malignant lung lesions are associated with significant changes in leukocyte concentrations. However, overlap of values between normal subjects and patients with cancer has limited the clinical utility of this determination. To decrease the overlap, 2,000 cells per differential determination were counted, and replicate automated cell counts were performed in blood samples obtained on different mornings between 7 and 9 A.M. Seventy-five patients who presented with undiagnosed lung lesions were analyzed. Benign and malignant lung lesions could be accurately distinguished by either relative granulocyte or lymphocyte counts. With 65.5 percent granulocytes as the cutoff, 86 percent of patients (38 of 44) proved to have lung cancer had higher values, and 97 percent of patients (30 of 31) with benign lesions had lower values. Likewise, with 28 percent lymphocytes as the cutoff, 87 percent of patients with lung cancer (39 of 44) had lower values, and 94 percent of patients (29 of 31) with benign disease had higher values. Relative monocyte counts were not different. Absolute leukocyte concentrations, although different for each group, had considerable overlap and thus were poor discriminators. These data suggest that precise analytical techniques and the use of relative leukocyte concentrations can improve the clinical utility of the leukocyte count as a discriminator of benign and malignant lung lesions.

Plasma steroids in benign prostatic hypertrophy and carcinoma of the prostate

Cortisol, 17-hydroxyprogesterone (17-OH-P), progesterone, testosterone, 5 alpha-dihydrotestosterone (DHT), estrone (E1) and estradiol (E2) were determined by RIA after chromatographic separation of steroids on Sephadex LH-20 columns, in 54 hospitalized patients with benign prostatic hyperplasia (BPH) and in 32 hospitalized patients with prostatic carcinoma (PCA) (T34, N01, M01). The patients' values were compared with those of 63 age-matched controls. Increased cortisol and DHT levels, subnormal estrogen and 17-OH-P values and normal progesterone level were found in both benign and malignant groups. Higher mean values for testosterone, and T/DHT ratio and lower mean values for E2/T ratio were found in PCA, as compared with those in BPH. An age invariance of cortisol, testosterone, T/DHT ratio and estradiol was found in both BPH and PCA, instead of the age dependence found in normal subjects. The normal relations between testosterone and its precursor (17-OH-P) and its peripheral metabolite (E2), respectively, and the normal relation between estrone and 17-OH-P were not evident in either BPH or PCA group. The normal direct relation between testosterone and DHT has been found in both patient groups.

Prognostic significance of immunological tests in lung cancer

We performed a battery of tests on peripheral blood samples from 94 patients with lung cancer to determine the extent to which immunological depression was due to abnormal lymphocyte function, as compared to changes in the number of lymphoid cells in the peripheral blood or in the efficiency of purification of cells in Ficoll-Hypaque gradients in preparation for testing. The percentage of lymphocytes in the gradient-derived cell suspension (%LG) was the most informative test. It decreased significantly with advancing stage of cancer and could predict survival of patients with uniform stage. The %LG correlated with survival better than any other test when multivariate analyses of all test combinations were performed. Low values of %LG reflected both the depressed lymphocyte counts and the altered buoyant density of the leucocytes of many patients with advanced cancer. A large proportion of the depression in other immune function tests was statistically attributed to changes in %LG. We concluded that this simple measurement provides valuable information about patients with lung cancer.

Persistent lymphocytopenia as a diagnostic feature of bronchogenic carcinoma

Patients with abnormalities due to bronchogenic carcinoma, noted on chest films, have decreased peripheral blood lymphocytes and increased total white cells compared to patients with benign lesions. Precision studies of 40 patients revealed that a low percentage of lymphocytes averaged over a three-week period distinguished bronchogenic carcinoma patients from patients with benign lesions with 95 percent overall accuracy. Lesions as small as 1.0 cm were correctly predicted to be malignant. Mean 8 AM plasma cortisol levels were elevated in patients with bronchogenic carcinoma and there was a negative correlation of 8 AM plasma cortisol levels with precentage of lymphocytes. Increased levels of endogenous cortisol may account for lymphocytopenia in bronchogenic carcinoma patients.

Correlation of pre-treatment serum 17-hydroxycorticosteroid values with survival in patients with prostatic cancer

Total 17-OHCS values were determined before and after treatment in 715 patients with all stages of prostatic cancer. The pre-treatment 17-OHCS level was an important variable in predicting survival and appeared to be a better prognostic indicator of death in the first year than the patient's age, treatment or stage of disease. Generally, the higher the initial value of serum 17-OHCS the greater the probability of death in the first year of treatment. There was no preponderance of one type of death over another when patients with initial high and low values were compared.

Serial measurement of plasma cortisol in lung cancer

Serial plasma cortisol estimations were carried out in 81 male lung cancer patients and in a control group of 50 male subjects with conditions other than lung cancer. It was found that group mean plasma cortisol levels, both in the morning and in the afternoon, were greater in the lung cancer patients than in the no-cancer control group. However, long-term assessment four years after the beginning of the study showed that high plasma cortisol levels were found predominantly in cancer patients within six months of death. If such patients are excluded from the study, there is no significant difference in group mean plasma cortisol levels between male lung cancer patients and a male control group.

Metabolic studies following thoracotomy for lung cancer with particular reference to postoperative atrial fibrillation

Atrial fibrillation has proved to be a frequent complication after thoracotomy for lung cancer. In order to study the possibility that metabolic changes are the trigger mechanism of these arrhythmias, free fatty acids (FFA), glycerol, triglycerides, serum insulin and glucose were determined pre- and postoperatively in patients both with and without this postoperative complication. In the primary series of patients, FFA were found to be increased immediately after the start of the atrial fibrillation, partly in relation to the morning values and partly to the 24-hour curve. This is a possible expression of an increased lipolysis in a causal relationship to the arrhythmia. In another series of patients, the degree of lypolysis was demonstrated using the glycerol values. With this method, no signs of increased lipolysis were found in connection with the onset of atrial fibrillation. Thus, changes in the lipoid metabolism were not found to be the trigger mechanism of the postoperative atrial fibrillation. Reduced values of serum insulin and glucose were not demonstrated either during the uncomplicated postoperative period or at the start of atrial fibrillation.

Albumin metabolism in rabbits and rats with transplanted tumours

Albumin distributions and turnover rates have been studied using (131)I labelled tracer material in rabbits with Vx2 carcinoma and rats bearing SP7 fibrosarcoma in comparison with control animals. Albumin concentrations were reduced in the tumour bearing animals but plasma volumes increased as the tumours developed. Relative increases were seen in the extravascular distribution of albumin, due partly to albumin pooling in and around the tumours and possibly also to general increases in capillary permeability. In the rats there was a considerable increase in the catabolic rate of albumin which was not related to urinary protein loss. The tumour bearing rabbits showed evidence both of increased catabolism and of decreased synthesis and the combination of the two effects resulted in a greater lowering of albumin concentration than was seen in the rats. Possible mechanisms for these findings and their significance in human malignant disease are discussed.

Adrenocortical activity in disseminated malignant disease in relation to prognosis

Adrenocortical activity has been assessed in patients with inoperable carcinoma of the bronchus or with disseminated malignant disease of other organs. The mean basal plasma cortisol level was higher in the former than in the latter and both were higher than the controls. Each had abnormally high midnight levels, particularly those with oat cell carcinoma of the bronchus. After the administration of a single dose of dexamethasone both groups suppressed poorly compared with the controls. Failure to suppress was associated with a poor prognosis.

A case of endocrine dysfunction with lung carcinoma

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