Adrenal activity in patients with advanced carcinomas

Thirty-nine patients with disseminated carcinoma but without metastases to the adrenal glands underwent a complete physical examination and laboratory work-up regarding signs and symptoms suggestive of adrenal insufficiency. Thereafter, they were categorized into two groups. In group A, 24 patients were in relatively good condition and had no symptoms suggestive of adrenal insufficiency. All 15 patients in group B had clinical signs and symptoms similar to those usually associated with adrenal insufficiency. The adrenal activity of each patient was evaluated through determination of cortisol in plasma at 8 am, 2 pm and 8 pm; dexamethasone suppression-adrenocorticotropic hormone stimulating test; analysis of 24 hour urinary excretion of cortisol, and analyses of 24 hour urinary excretion of epinephrine and norepinephrine. After completion of the evaluation of adrenal function, the patients included in group B were treated with cortisone acetate. Patients in group B, when compared with those of group A, generally had an increase in cortisol secretion as well as in epinephrine and norepinephrine excretion. Both groups responded to dexamethasone suppression and adrenocorticotropic hormone stimulation. Of the 13 patients treated with cortisone, only one patient objectively responded to the treatment, while two of the patients were clinically improved. All three of these patients had normal or increased adrenal activity. It was concluded that the symptoms frequently seen in patients with disseminated carcinoma and which are similar to those associated with adrenal insufficiency, do not indicate impaired cortisol secretion. Patients with these symptoms usually had an increase in adrenal activity, probably as a response to stress.