慢性心不全に於ける肝障碍と副腎皮質機能に関する研究
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概要
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The function of the adrenal cortex has been studied in patients with chronic cardiac failure, and it was found that the secretory activity of the adrenal cortex showed a marked fall, and plasma levels and urinary excretion of corticoids showed significant decreases in these patients in comparison with normal subjects. Especially, in serious cases, it was characterized that the value of the conjugated form of the corticoids in both blood and urine were extremely low.<BR>Also in patients with chronic cardiac failure, it was observed that the functional and histological changes in the liver were parallel with the grade of cardiac failure.<BR>The fate of the orally administered hydrocortisone has been studied in patients with cardiac failure. The disappearance of hydrocortisone from blood was slower in these patients than in normal subjects, and also its urinary excretion extremely delayed in proportion to the grade of the hepatic dysfunction.<BR>To confine the above mentioned experiments, thoracic inferior vena cava constriction was produced in the dogs. The functional disturbance of the liver was found in one to two weeks after the constriction and was at its maximum in three to four weeks; on the other hand, the fibrosis was found in every zone of the adrenal cortex, indistinct nuclei and fatty degeneration without blood congestion, in three to four weeks.<BR>In these experimental dogs, the author observed the disturbance of corticoid metabolism, such as the delayed disappearance of the intravenously infused hydrocortisone from blood and the reduced difference of the plasma 17-OHC. S. level between the femoral artery and the hepatic vein.<BR>The plasma level of 17-OHC. S. gradually elevated after the vein constriction and reached at its maximum in two weeks. In the stadium which showed the functional and histological changes in the liver, the adrenal cortex showed normal finding. Then, the plasma level of 17-OHC. S., distinctly fell in three to four weeks, namely in the stadium which showed the fibrosis of the adrenal cortex.<BR>From these facts, it was suggested that the high plasma level of free 17-OHC. S. in one to two weeks, was produced by the metabolic disturbance of the corticoid due to hepatic dysfunction.<BR>It will be discussed that as the results of the inhibition of the ACTH secretion due to the continuance of the high plasma level of free 17-OHC. S., the dysfunction of the adrenal cortex was caused.
- 一般社団法人 日本内分泌学会の論文