Abnormalities of Albumin Metabolism in Patients with Hypogammaglobulinemia*

Abstract

The serum albumin concentration was determined in 24 patients with defective gamma-globulin synthesis, including groups with congenital hypogammaglobulinemia, idlopathic acquired hypogammaglobulinemia, and hypogammaglobulinemia secondary to neoplastic disease. In 20 of the 24 patients the serum albumin concentration was below the lower normal limit of 3.6 g/100 ml. Each of the 8 patients with a serum albumin concentration below 3 g/100 ml had significant gastrointestinal symptoms. The albumin metabolism in 6 of the patients with hypoalbuminemia and diarrhea was studied with I131-labeled albumin and I131-iabeled poly-vinylpyrrolidone. In each of these the total body albumin pool was reduced. In 4 there was defective albumin synthesis, and in 2 the rate of albumin synthesis was within normal range. In 3 of the patients excessive loss of albumin into the gastrointestinal tract was a significant factor in the hypoalbuminemia. After treatment of these patients with antibiotics, gluten-free diet or corticosteroids, the abnormal enteric loss of albumin diminished or ceased completely, with a return of serum and total body albumin levels to normal. However, the primary defect in gamma-globulin synthesis was not affected by the therapy. The primary disorder in all these patients was presumably defective gamma-globulin synthesis. However, an associated secondary disorder of the intestinal mucosa could be seen, with consequent general enteric loss of the serum proteins.