An i.v. infusion dexamethasone (Dex) test was used to investigate the ACTH feedback response in 9 normal subjects, 12 obese patients, and 11 patients with Cushing's syndrome. Dex phosphate was infused iv for 4 h, starting at 1100 h (1 mg/h). Plasma concentrations of beta-lipotropin (beta LPH) and cortisol were measured every 20 min between 0900 and 1600 h, then every 2 h until midnight and at 0900 h the next day. In normal subjects and obese patients, plasma beta LPH and cortisol concentrations fell rapidly to less than 40 ng/liter and 3 micrograms/dl, respectively, at the end of Dex infusion. Subsequent values remained low through 0900 h the next day. In 7 patients with Cushing's disease, basal plasma beta LPH and cortisol concentrations declined by greater than 50% during the Dex infusion. In these patients, rapid escape from suppression occurred between 1600 and 2400 h; by 0900 h the following day, beta LPH and cortisol levels were higher than 100 ng/liter and 10 micrograms/dl, respectively. In 3 patients with adrenal tumors, beta LPH concentrations were low, and cortisol concentrations did not decline during the Dex infusion. In 1 patient with ectopic ACTH secretion, beta LPH concentrations were high and were not suppressed by the Dex infusion. We conclude that the iv infusion Dex suppression test can distinguish patients with Cushing's syndrome from normal or obese subjects and can aid in the etiological diagnosis of Cushing's syndrome.
The 24-h plasma cortisol profile was obtained at 20-min intervals in 18 patients with Cushing's syndrome (10 with Cushing's disease, 5 with adrenal adenoma, 2 with ectopic ACTH secretion and 1 of questionable aetiology). The mean cortisol level was maximum in the case of ectopic ACTH secretion. The
The effects of progesterone or 17 alpha-hydroxyprogesterone on corticosterone regulation of beta-endorphin (beta-end) release have been studied in vitro using primary culture of rat anterior pituitaries. Incubation of pituitary cells with ovine corticotropin-releasing factor (CRF) for 2 h resulted in a dose-dependent increase in beta-end release. Maximal stimulation was obtained with 200 ng/ml CRF. Preincubation for 2 h with corticosterone resulted in a dose-dependent inhibition of CRF-induced beta-end release. When the cultures were preincubated for 2 h with 200 ng/ml corticosterone and increasing concentrations (1, 10, 100, 1,000, and 10,000 ng/ml) of progesterone, a significant decrease in the corticosterone feedback action was observed with 100 ng/ml progesterone. Complete inhibition of the action of 200 ng/ml corticosterone was achieved with 10,000 ng/ml progesterone. Moreover, when the cultures were preincubated with increasing concentrations of corticosterone in the presence of 100 ng/ml progesterone, the ED50 of corticosterone increased significantly from 212 +/- 36 to 940 +/- 42 ng/ml (mean +/- SEM; P less than 0.01). Under the same conditions, 17 alpha-hydroxyprogesterone had no effect. These data demonstrate that progesterone antagonizes the corticosterone feedback inhibition of beta-end release by rat anterior pituitary.
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