副腎全剔後の尿中Catecholamineの推移
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概要
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Catecholamine, as well as adrenal cortical hormone, has been recently recognized as indispensable to maintain the homeostasis of the circulatory system. There are few reports about the relation between adrenal cortical hormone and catecholamine in bilateral adrenalectomized patient. In this paper, the urinary output of catecholamine before and after adrenalectomy was investigated and the effects of cortisone, ACTH, and DOCA on urinary catecholamine excretion were also studied. <BR>The results were as follows : <BR>1) Adrenaline excretion decreased one third or one fifth of normal value after the bilateral adrenalectomy, and, even three years after the operation, the excretion still remained at low level. It is noteworthy that the urinary excretion of adrenaline was always found after the operation in all cases, although the quantity was small. It might be supposed that the persistent adrenaline is derived from chromaffine cells other than adrenal medulla. <BR>2) On the other hand, the excretion of noradrenaline was about twice as much of that before the bilateral adrenalectomy at one month after the operation, and it rose up to three or four times at three months after surgery. But this elevated value declined again to normal level in about six or twelve months later. <BR>3) The urinary excretion of noradrenaline, that increased after the bilateral adrenalectomy, was significantly decreased by cortisone, whereas there was no change by DOCA. These findings suggest that the excretion of noradrenaline is mostly influenced by glucocorticoid rather than mineralocorticoid. <BR>4) The blood pressure was labile immediately after the bilateral adrenalectomy, but stabilized four days after the operation by a proper supply of corticoids. Only nine of twenty four cases required noradrenaline in order to maintain normal blood pressure during the operation ; none of the cases required it four days after the operation. The above results lead to the conclusion that the replacement therapy in adrenalectomized patients does not require catecholamine substitution. <BR>5) The blood pressure fell markedly after the withdrawal of corticoid replacement therapy in bilateral adrenalectomized patients. It reterned to normal level by the administration of corticoids. Pressor effects of noradrenaline was slight in adrenalectomized patients, whereas the effect was increased by the combined administration of noradrenaline and glucocorticoid. These facts suggest that the role of noradrenaline is synergistic with corticoids. <BR>6) The response of blood pressure to subcutaneous administration of noradrenaline was depressed soon after the bilateral adrenalectomy but it returned gradually to normal. This may be one of the reasons why the urinary excretion of noradrenaline increased after the adrenalectomy.
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