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The Value of Urinary Steroid Estimations in the Prediction of Response to Adrenalectomy or Hypophysectomy

( Division of Chemistry and Biochemistry, Imperial Cancer Research Fund, Lincoln's Inn Fields, London, W.C.2, and Department of Surgery, Guy's Hospital, London, S.E.1, England)

A discriminant function based on the results of determinations of the urinary 17-hydroxycorticosteroids and etiocholanolone has been found to be related to response to adrenalectomy or hypophysectomy. This has been tested in a clinical trial where patients with positive discriminants were selected for hypophysectomy and patients with negative discriminants for adrenalectomy. In this trial the results of hypophysectomy were significantly better than those of adrenalectomy. Also the results of adrenalectomy were significantly worse than a previous series in which the operation was selected by random sample. Preliminary data are given on a reversal of this trial where patients with negative discriminants are selected for hypophysectomy and patients with positive discriminants for adrenalectomy. The total experience of the use of the discriminant is described. The response to adrenalectomy or hypophysectomy of 77 patients with positive discriminants is shown to be significantly better than that of 82 patients with negative discriminants when compared by survival, mean clinical value, and success rate.