Vari ati ons in palliative response of breast cancer to adrenalectomy can be explained either by variations in the glands removed, by variations in the biology of the neoplasm, or by variations in the host herself. Most of the reported studies of this subject have been devoted to the latter two concepts; seeking to discern either in the tumor (the anatomy of its metastases, its growth rate), or in some aspect of the host (the free interval, age, or menopausal status) some indicator of the anticipated response. Recently, attention has been devoted to the urinary hormone excretion as a measure of adrenal function, and subsequent derivation from that information of a discriminant or predictor of clinical response.A previous report compared the extent of adrenal atrophy observed after prolonged corticosteroid treatment with that observed following hypophysectomy in patients with advanced carcinoma of the breast.1 Hypophysectomy produced a far more profound adrenal atrophy than did corticosteroid administration; in the group treated with corticosteroids, the atrophy was maximal after 15 to 20 weeks of therapy, and there was no further anatomical change with further treatment. The adrenocortical width was found to be the most sensitive and easily measured index of adrenal atrophy. It appeared that excellent responses were often obtained from patients who later had ex¬ tremely atrophie glands.Morphologie attributes of the adrenal glands (removed at adrenalectomy) have been correlated in the present study with the functional perform¬ ance of the glands prior to operation, measured in terms of the resting and corticotropin (ACTH)stimulated urinary excretion of 17-hydroxycorticosteroids (Porter-Silber chromogens) and 17-ketosteroids (Zimmerman). A comparison of these data with the clinical results of adrenalectomy is also presented.Although resting urinary hormone excretion pro¬ vides base line data on adrenal function, the re¬ sponse to corticotropin, referred to here as the increment, should provide a more significant index of adrenal secretory capacity, as the gland is there¬ by driven to maximum performance. The ratio of the increment in urinary hormone excretion re¬ sulting from corticotropin stimulation to the rest¬ ing value is termed the "incremental ratio." In these patients, measurements of the adrenal capacity for estrogen production have been car¬ ried out using resting urinary estrogen levels and isotope dilution techniques to determine estrogen secretory rate. Preliminary information from these studies will be presented briefly here; the estrogen data will be reported in detail at a later time.
Materials and MethodsFifty-six women with disseminated carcinoma of the breast underwent bilateral simultaneous adrenalectomy at the Peter Bent Brigham Hos¬ pital
