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When malabsorption develops during the course of Whipple's intestinal lipodystrophy, it is often accompanied by hypoalbuminemia. Among 53 case reports published between 1951 and 1964 for which values of the concentration of albumin in the serum were presented, there were 43 values below 3.5 g per 100 ml (Figure 1). A decrease in the concentration of albumin in the serum may be due to dilution or to a decrease in the size of the body's total exchangeable pool of albumin. A reduction in the albumin pool size may result from decreased synthesis, from increased catabolism or loss, or from both causes. To explore the factors responsible for the hypo-albuminemia of Whipple's disease, we studied the albumin metabolism of seven patients with this disorder. Albumin labeled with 131I or with 125I was used to measure the total exchangeable pool of al-bumin and the rates of albumin catabolism and synthesis. Albumin-51Cr was used to measure loss of albumin into the gastrointestinal tract. The patients were studied when their disease was in relapse and again when therapy had induced marked improvement. The data suggest that abnormal exudation of serum protein into the gastrointesti-nal tract is an important factor in causing the hypo-albuminemia of Whipple's disease, that treatment of the disease can reverse this exudative enterop-athy relatively rapidly, and that impairment of al-bumin synthesis may be associated with the exu-dative enteropathy. Methods Clinical. Six of the seven patients were first seen at the Clinical Center of the National Institutes of Health when their Whipple's disease was in mild to severe relapse. E.W. was in remission when first seen and remained off therapy for 3 years, when her disease again relapsed. In each patient the diagnosis of Whipple's disease in relapse was established by the demonstration in the lamina propria of the small intestinal mucosa of characteristic macrophages containing material that reacted with the periodic acid-Schiff stain. Electron microscopy revealed bacillary bodies (2) that disappeared from the intestinal mucosa soon after the onset of remission. Tests of intestinal absorptive functions gave abnormal results (Table I), but tests of hepatic and renal functions did not. A.W. was treated with antibiotics only; the others were treated with antibiotics and adrenocorticosteroids. All seven developed remissions. Detailed descriptions of the clinical and pathological features of these patients will appear elsewhere.

Albumin metabolism in patients with Whipple's disease.