The Excretion of Urinary Neutral 17-Ketosteroids Following Bilateral Splanchnicectomy and Right Adrenalectomy

Abstract

The aim of the present study has been to discover whether the total urinary excretion of neutral 17-ketosteroids is affected by division of the nerves supplying the adrenal glands, with or without complete removal of one adrenal gland.During treatment for essential hypertension, selected patients undergo bilateral splanchnicectomy resulting in complete section of the nerve supply of the adrenal glands, and in addition right-sided adrenalectomy may be performed. It is thought that in women the urinary 17-ketosteroids are derived from the adrenals only, and that the ovaries probably play no part in their production, since \l=o"\ophorectomy does not significantly alter the excretion [assays have been reported in women suffering from Addison's disease [Fraser et al. 1941].Accordingly two female patients undergoing surgical treatment for essential hypertension were selected for this investigation.Low excretions have been reported in some hypertensive patients by Bruger, Rosenkrantz & Lowenstein [1944] and Selye [1947], but as Talbot & Butler [1942] and other workers have shown, there is a tendency in chronic illness from any cause for the 17-ketosteroid excretion to be moderately low.Forbes, Donaldson, Reifenstein & Albright [1947] found that in relatively healthy patients various types of acute trauma (e.g. operations, burns, acute infections) resulted in a definite pattern of 17-ketosteroid excretion. Within 24-48 hr. of operation there was an increase in excretion to a higher level than normal followed by a rapid fall to a low level on the fourth or fifth day, with a return to normal levels in 10 days. The peak which preceded the fall tended to be more marked in men than in women. When the patients were chronically ill or debilitated the response to trauma was only slight or absent altogether. Their patients included three men who had had bilateral lumbodorsal splanchnicectomy performed in two stages for essential hypertension, and their 17-ketosteroid excretion followed the typical pattern with an eventual return to pre-operative levels. In view of these findings, the period between the two operations in our patients for this investigation was greater than 10 days, and excretion after the second operation was observed for longer than 10 days in order to be certain that the post-operative phase was over.