Using a specific and sensitive assay procedure, we have tested the urine of normal persons and of patients having a variety of disease states for its adrenotrophic activity. Tests using both fresh urine and urine concentrates prepared in three different ways were carried out. Contrary to previous reports, no adrenotrophic activity could be consistently demonstrated.
In the last five years, at The Mayo Clinic, four patients have been seen who had exophthalmic goiter, and who were subject to attacks identical clinically with those seen in the syndrome known as familial periodic paraylsis. To our knowledge, similar cases have not been reported in the English language. Further investigation of cases of this sort may eventually disclose the fundamental pathologic physiology of familial periodic paralysis, and possibly will help to solve some of the problems associated with the unique muscular weakness seen in exophthalmic goiter. Consequently, we felt that it was desirable to report these four cases. To date, the diagnosis of familial periodic paralysis has been made at The Mayo Clinic in only three instances, exclusive of the four cases under consideration. Taylor stated that familial periodic paralysis has certain constant and cardinal peculiarities. Thus, it is characterized in its typical manifestation by hereditary transmission, periodicity, confinement to the motor portion of the nervous system, electrical changes, and finally, by the practically perfect health of the patient in the free intervals.
IN 1941 two procedures to assist in the recognition and exclusion of Addison's disease were described by Robinson and two of us [Power and Kepler (30)]. These procedures have since become known as the “water test.” It is the purpose of this review to consider the rationale of the test and to evaluate it specificity in the diagnosis of chronic adrenal cortical insufficiency. Data obtained at the Mayo Clinic during the period from January, 1941, to May, 1945, inclusive, have been utilized. The two procedures which comprise the “water test” were considered separately and in combination. The following description and interpretation of the water test are reproduced in part from the original article of Robinson, Power and Kepler (30). Procedure I (based on volume of urine).—On the day before the test the patient eats three ordinary meals but omits extra salt. He is requested not to eat or drink anything after 6 p.m. Until this time he may drink water as desired. At 10:30 p.m. lie is requested to empty his bladder and discard the urine. All urine which is voided from then on until and including 7:30 a.m. is collected. The volume of this urine is measured and it is saved for chemical analysis. Breakfast is omitted. The patient is asked to void again at 8:30 a.m. and immediately thereafter he is given 20 cc. of water per kilogram of body weight (9 cc. per pound). He is asked to drink this within the next forty-five minutes. At 9:30, 10:30 and 11:30 a.m. and 12:30 p.m. he is requested to empty his bladder. In order to eliminate the effects of exercise and posture on urinary excretion, he is kept at rest in bed except when up to void. Each specimen is kept in a separate container. The volume of the largest one of these four specimens is measured. Under these conditions some patients having Addison's disease exorete so little urine that they- are unable to void more than once or twice during the entire morning. …
CLINICAL pictures which accompany functioning tumors of the adrenal cortex are neither specific nor diagnostic. Other pathologic conditions produce similar or even identical symptoms. Only one of these other conditions need be mentioned here; namely, adrenal cortical hyperplasia.* For therapeutic reasons it is very important to distinguish cases of adrenal cortical tumor from adrenal cortical hyperplasia and from the other clinical and pathologic entities which simulate both of them. The discussion that follows centers around the chemical and biologic methods that can be employed to help make these distinctions. Urine of patients who have functioning adrenal cortical tumors usually contains excessive amounts of both androgens and 17-ketosteroids. The former can be determined only by biologic methods, whereas the latter, which include not only androgenic steroids but others which seem to be biologically inert, can be determined by chemical methods. Kenyon, Gallagher, Peterson, Dorfman and Koch (1937) (27) were among the first to demonstrate that there may be large amounts of androgenic material in the urine excreted by patients having these tumors. They studied fifteen cases of “virilism” among women. Twelve patients excreted normal amounts of androgens, two excreted 25 per cent more than normal and one, who had a carcinoma of the adrenal cortex, excreted very large amounts. Similar observations were made by R. K. Callow (1938) (11). He determined both the androgen and the 17-ketosteroid content of the urine. In his series of cases there was one woman who had Cushing's syndrome, also a girl aged nineteen years who had an adrenal cortical tumor, and several women who were virilized but who presumably did not have adrenal cortical tumor. Only in the case of adrenal tumor was there found an increase of the urinary content of both androgenic and 17-ketosteroidal material. Callow therefore came to the conclusion that “adrenal tumor can be diagnosed with the aid of androgen assay.” Levy Simpson (1938) (31), however, in a discussion of Callow's paper, pointed out that Callow's conclusion should be qualified since, in Levy Simpson's experience, the urine of patients having adrenal cortical hyperplasia sometimes contained amounts of androgenic material comparable to those obtained in cases of adrenal cortical tumor.
IT is commonly assumed that growth of cutaneous hair, excluding that of the scalp and eyebrows, is a manifestation of anterior pituitary and gonadal function or of gonadal function only. Clinical evidence, especially that derived from the hirsutism which accompanies tumors of the suprarenal cortex makes one reluctant to accept this assumption. The case history which follows makes one even more skeptical. The patient had a normal feminine habitus, normally developed breasts and, after her menses had become well established, practically normal menstrual periods. It is highly probable, therefore, that ovarian and anterior pituitary functions were essentially normal.1 Nevertheless, there was almost complete absence of cutaneous hair except for that of the scalp and eyebrows. In view of the fact that the patient had Addison's disease, it seems very likely that in her case, at least, failure of growth of the ‘sexually conditioned’ hair was almost certainly the result of insufficiency of function of the suprarenal cortex.
