American Journal of Clinical Nutrition, Vol 9, 186-195, Copyright © 1961 by The American Society for Clinical Nutrition, Inc.

Role of the Adrenal Cortical System in the Response of Children to Severe Protein Malnutrition

¹ From the Institute of Nutrition of Central America and Panama (INCAP), and Roosevelt Hospital, Guatemala, C. A.

Six children with kwashiorkor upon admission were found to excrete significantly less 17-hydroxysteroids than five with marasmus although the 17-ketosteroid excretion was not significantly different in the two groups. Eosinophil counts were low in both conditions, but more markedly decreased in marasmus. Intramuscular administration of a single 10 I.U. dose of ACTH produced a sharp rise in the excretion of 17-hydroxysteroids in children with kwashiorkor but had little effect in those with marasmus. With two to eight weeks of treatment these differences disappeared even after stimulation with ACTH.

These findings were duplicated in rats fed a low-protein diet and then given either placebo, cortisone, ACTH or DOCA. Cortisone caused a marked increase in serum albumin and liver protein and a decrease in liver fat but with the other treatments these effects were not noticed. A marked degree of muscle wasting has been demonstrated histologically and chemically in the groups given cortisone. None of the treatments caused any change in the results of the measurements in well nourished rats. Thus, the child with marasmus resembled the protein-deficient rat given cortisone while the child with kwashiorkor was similar in several basic ways to protein-deficient rats given DOCA or sodium chloride. By analogy with gluconeogenesis, the term "proteoneogenesis" is used to define the synthesis of liver protein and serum albumin from muscle amino acids. The present findings were interpreted as an indication of predominance of "proteoneogenesis" over gluconeogenesis in the protein-deficient animal in the presence of hyperglucocorticoid activity.