Circadian Secretion of Acth, Cortisol, and Mineralocorticoids in Cushing's Syndrome

Boscaro, Marco; Scaroni, Carla; Masarotto, P; Ridolfi, P.; Benato, Marcel Luiz; Mantero, Franco

doi:10.3109/10641968209061641

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…- 20 In the present study we also observed that the plasma cortisol level remained high throughout the day with little rhythm in patients with Cushing's syndrome (data not presented). Exogenous glucocorticoid also disturbs the ordinary hypothalamic-pituitary periodicity.…”

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confidence: 62%

Altered circadian blood pressure rhythm in patients with Cushing's syndrome.

et al. 1988

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SUMMARYThe circadian blood pressure rhythm was compared in patients with Cushing's syndrome, essential hypertension, and primary aldosteronism. In patients with essential hypertension or primary aldosteronism, a dear nocturnal fall hi systolic and diastolk blood pressure and heart rate was observed. This fall was seen in untreated subjects as well as hi patients receiving combined treatment with a calcium antagonist, diuretic, converting enzyme inhibitor, a-blocker and 0-blocker, or sympatholytic drug. In these groups, there was a positive correlation between heart rate and systolic or diastolic blood pressure. On the other hand, hi patients with Cushing's syndrome, there was no nocturnal fall hi blood pressure but in some patients a rise was observed. In all patients there was a nocturnal fall hi heart rate. Thus, there was no significant correlation between heart rate and blood pressure hi these patients. Exogenous glucocortkoid eliminated the normal nocturnal fall of blood pressure hi patients with chronic glomerulonephritis or systemic lupus erythematosus. These results suggest that the changed circadian blood pressure pattern hi patients with Cushing's syndrome is not due to antihypertensive treatment or to the mineralocorticold excess accompanying this disease, but it is attributable to excess glucocorticoid or the associated disturbance hi the adrenocorticotropic hormone-glucocorticoid system (or both). This conclusion also implies that the normal circadian rhythm of blood pressure may be regulated at least in part by the adrenocorticotropic hormone -glucocorticoid system. and it has been shown that BP reaches a nadir at approximately 0300, begins to rise again at 0500, and reaches its highest level at about 0900. The latter increase is said not to be associated with physical activity.1 Several researchers have claimed that the fluctuations observed in BP are related to daily activities such as sleep and physical exertion 2 -5 rather than the presence of an independent BP

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supporting

confidence: 62%

Altered circadian blood pressure rhythm in patients with Cushing's syndrome.

et al. 1988

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“…The dissociation of the circadian rhythm of BP from that of HR is consistent with results in Cushing's syndrome 5 and suggests that independent mechanisms regulate HR and BP. The impaired circadian rhythm of Cortisol secretion, which has been demonstrated in certain conditions, 5,23,28 may be important in the observed alteration in the circadian rhythm of BP.…”

Section: Discussionmentioning

confidence: 94%

Absence of Nocturnal Fall in Blood Pressure in Elderly Persons with Alzheimer‐Type Dementia

Otsuka

Mikami

Katahira

et al. 1990

J American Geriatrics Society

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Circadian changes of the blood pressure and heart rate in elderly normotensive bedridden patients with severe dementia of the Alzheimer type (group D) were compared with those in elderly normotensive bedridden patients without dementia (group R), normotensive subjects with normal daily activity (group N), and hypertensive patients with normal daily activity (group H). In groups R, N, and H, the blood pressure increased in the afternoon and decreased at midnight; in group D, however, although it increased in the afternoon, it did not decrease at night. The circadian changes of the heart rate were similar in all four groups, showing maxima in the afternoon and minima at midnight. Thus, a specific alteration was found in the circadian rhythm of the blood pressure in patients with Alzheimer-type dementia.

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“…Aldosterone levels ranged from suppressed to high in our patients. It is well known that aldosterone levels may vary greatly in patients with Cushing's disease (Shambelan et al, 1971;Boscaro et al, 1982). A transient intra-adrenal block of the 'late-pathway' of mineralocorticoid production following sustained ACTH stimulation might also play a role (Biglieri et al, 1969; Boscaro et a/., 1982).…”

Section: Discussionmentioning

confidence: 99%

Response of Pituitary‐adrenal Axis to Corticotrophin Releasing Hormone in Patients With Cushing's Disease Before and After Ketoconazole Treatment

Boscaro

Sonino

Rampazzo

et al. 1987

Clinical Endocrinology

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Ketoconazole is an antimycotic agent and a potent inhibitor of gonadal and adrenal steroidogenesis. It has been used successfully as a palliative treatment of Cushing's syndrome due to its ability to lower cortisol production. However, the effects of ketoconazole on ACTH and aldosterone secretion have not yet been clarified. We evaluated the effect of ovine corticotrophin releasing hormone (oCRH) (100 micrograms bolus) on plasma ACTH, cortisol and aldosterone levels in six patients with Cushing's disease before and after 4 to 6 weeks of treatment with ketoconazole 600 mg/d. Before treatment, plasma cortisol levels were high and significantly increased after oCRH stimulation in all cases, while various patterns of aldosterone secretion were observed. Patients with higher levels showed a greater response to oCRH, while two patients with very low aldosterone showed no response. ACTH showed a marked rise after oCRH administration in all patients with a maximum peak at 30-45 min. After ketoconazole treatment, both plasma cortisol and aldosterone were lowered and their response to oCRH was impaired. Basal ACTH levels were increased in four patients and ACTH response to oCRH was enhanced in all, compared to pretreatment. These findings confirm the inhibitory action of ketoconazole on basal and stimulated cortisol secretion. A similar inhibition affected aldosterone production, indicating that ketoconazole also interferes with the mineralocorticoid pathway. The enhanced response of ACTH to oCRH after the administration of ketoconazole argues against an inhibitory effect of this agent at the pituitary level and might best be explained by reduced negative cortisol feedback.

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Circadian Secretion of Acth, Cortisol, and Mineralocorticoids in Cushing's Syndrome

Cited by 8 publications

References 16 publications

Altered circadian blood pressure rhythm in patients with Cushing's syndrome.

Altered circadian blood pressure rhythm in patients with Cushing's syndrome.

Absence of Nocturnal Fall in Blood Pressure in Elderly Persons with Alzheimer‐Type Dementia

Response of Pituitary‐adrenal Axis to Corticotrophin Releasing Hormone in Patients With Cushing's Disease Before and After Ketoconazole Treatment

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