Diurnal Variation in the Urinary Excretion of Neutral Lipid-Soluble Reducing Steroids in Congestive Cardiac Failure and Cirrhosis of the Liver With Ascites 12

Abstract

Pincus and his collaborators (1-4) have demonstrated that there is a normal cycle of excretion of neutral, lipid-soluble reducing steroids which has a maximum between 7 a.m. and 11 a.m., decreases during the afternoon, and is at a minimum during the night. This corresponds to the normal excretory cycle of other urinary constituents (5-13). It has also been shown that in congestive cardiac failure (14, 15) and in cirrhosis of the liver with ascites (16) there is a reversed diurnal cycle of water and sodium excretion, with maximum values during the night in a high proportion of the individuals studied. This investi1Reviewed by the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions of the authors are the results of their own study and do not necessarily reflect the opinion or policy of the Veterans Administration.2This investigation was supported (in part) by a research grant from the National Heart Institute, of the National Institutes of Health, Public Health Service.gation was designed to determine if the excretion of steroids was also altered by these conditions. MATERIAL AND METHODSTen normal male adults were used as controls. Fourteen male patients with congestive heart failure, of various etiologies and in differing degrees of decompensation, and 12 male patients with cirrhosis of the liver and ascites comprised the abnormal groups. Almost all of the patients were on a standard hospital diet containing a calculated 1,000 milligrams of sodium daily. Diuretics were not used within 48 hours of the urine collection periods, and no clinical evidence of urinary obstruction was present. Three consecutive, eight-hour, spontaneously voided urine specimens were collected from each individual. The one collected between 6 a.m. and 2 p.m. was designated the morning specimen, the one collected between 2 p.m. and 10 p.m. was designated the afternoon specimen, and the one collected between 10 p.m. and 6 a.m. was designated the night specimen. The time of the night specimen was chosen so that it would coincide most closely with the hours of sleep. The volume of each urine was measured and the quantity of neutral TABLE I

17-Hydroxycorticosteroid Metabolism in Liver Disease1

“…These results do not agree with those of other workers (16)(17)(18)(19)(20) who measured urinary corticoids by less specific methods. Although the ACTHinduced rise in the plasma 17-hydroxycorticosteroid level in the patients with liver disease was of the same magnitude as in the normal subjects, this implies a decreased adrenocortical secretion of 17-hydroxycorticosterone since its removal was impaired.…”

The Relationship of the Renal Excretion of Adrenal Corticoids to Variations in Renal Hemodynamics 1

“…Goldman and Bassett (12) noted that the excretion of neutral lipidsoluble reducing steroids was proportional to the excretion of creatinine in their study of patients with cirrhosis and congestive heart failure and suggested that the excretion of corticosteroids may be proportional to the filtration rate. As no information is available at present regarding the filtrability of adrenal corticoids through the glomerular membrane, it is not possible to decide whether the changes in hormone excretion were due to changes in the amount filtered, or in tubular reabsorption or tubular secretion or hormone.…”

Adrenocortical Steroid Metabolism and Adrenal Cortical Function in Liver Disease

“…Although urine levels of "corticoids" have been reported to be normal or elevated in acute hepatitis (21) and cirrhosis (21,23,25,(29)(30)(31), the data in these studies are difficult to interpret because of the nonspecific methods of assay used. Brown,320 Willardson, Samuels and Tyler (32), using a more reliable assay method, found the urinary corticoids to be low in cirrhosis.…”