Excretion patterns of 17-ketosteroids and 17-hydroxycorticosteroids in surgical stress

The neuroendocrinology of physical injury

Physical injury of any sort--accidental injury, burns or elective surgery--provokes an immediate neuroendocrine response. Neural input arising from the cerebral cortex, damaged tissues and receptors detecting fluid loss leads to increased secretion of ACTH, growth hormone, prolactin and vasopressin from the pituitary, and to a general activation of the sympathetic nervous system, with rises in adrenaline and noradrenaline concentrations. Secondary changes include stimulation of cortisol and aldosterone and inhibition of insulin and somatomedin secretion. The glucagon concentration and plasma renin activity may also be increased, either immediately or after a delay. The duration of these responses generally depends upon the severity of the injury and differs considerably between hormones, for reasons that are not understood. The only endocrine changes consistently seen at later times after trauma are an increase in insulin secretion, which supersedes the initial suppression, and decreases in the concentrations of T3 and gonadal steroids. Some of the changes in steroid, thyroid and pancreatic hormones differ temporally or even qualitatively from those of their usual stimuli and are unexplained. The initial neuroendocrine response to injury can be construed as playing a defensive role, but the function of the later changes is not understood; it seems likely that they are adaptive in nature, but the scope for therapeutic intervention remains unclear.

Steroid hormones and human breast cancer. An hypothesis

The likely occurrence of two distinct types of human breast cancer is discussed. In the development of the "Western-environmental" or "adrenal" type, it is proposed that dehydroepiandrosterone sulphate (DHEAS), secreted by the adrenal, may be implicated. This steroid is metabolized by mammary tumors to active androgens and estrogens. That these metabolic pathways are very similar to that in skin is emphasized and this is possibly explained by evolution of the mammary gland from primitive sweat glands. Formation of DHEAS from DHEA in mammary tumors, claimed to be correlated with an individual subject's prognosis and response to hormone ablation, is discussed in the light of a possible regulatory role of the sulphotransferase. It is proposed furthermore that a specific control of DHEAS secretion in the adrenal may exist at the level of the sulphurylation step. Nutritional factors are also possibly implicated here and these are discussed in the light of: 1) a possible higher secretion rate of DHEAS in obese subjects; and 2) the low breast cancer incidence in the Japanese and the accompanying low blood DHEAS levels.

Effect of obesity on the hypothalamo-pituitary-gonadal function in childhood

In 22 normal and 35 obese boys a gonadal function test (2000 IU of hCG i.m. daily for three days and assays of plasma testosterone before and after the hCG administration) was carried out. All the "short normal" children and 31 obese subjects underwent the LH-RH test (50 microng i.v.). While basal testosterone was similar in the two groups of children, after hCG testosterone was significantly (p less than 0.001) lower in the obese boys, In the normal children a significant positive correlation between bone age and basal and after hCG testosterone was demonstrated; this correlation was not found in the obese boys. The pituitary reserve of gonadotrophins did not show significant differences between the two groups of children. Finally a significant positive correlation (p less than 0.01) between the LH curve area during the LH-RH test and bone age was found only in the normal boys.

Response of solitary adrenal gland to surgical stress

Available reports on adrenal function following unilateral adrenalectomy mainly concern the gland's activity under basal conditions. Its response to superadded stress has largely escaped attention. The present communication deals with changes in morphology and in the behavior of acid phosphatase, non-specific esterases and 3beta-hydroxysteroid dehydrogenase in solitary adrenal glands following operative trauma. Histochemical, electrophoretic and biochemical techniques have been employed in the study. Although the morphological response to identical trauma on both unilaterally adrenal-extomized and intact animals is indistinguishable, the enzymological response is strikingly different in the two groups. While in the latter, the enzyme activities exhibit an early rise following trauma, the same is delayed by another 8 hr in the former. In experments using ACTH, the overall pattern of exterase activity shows little deviation from that observed in untreated cases in both groups of animals. The findings indicate that in unilaterally adrenalectomized animals, susperadded operative stimuli fail to evoke the early response characteristic of the normal adrenal glands. Such latency points to the vulnerability of their existing defence mechanisms. The remarkable similarity of adrenal response with or without exogenous ACTH in these animals suggests that the reason for a delayed response is rooted in the target organ itself, and is not due to an altered plasma ACTH level.