Pituitary Response to Stress in Cushing's Disease

Werder, K. Von; Smilo, Renata P.; Hane, Satoshi; Forsham, P. H.

doi:10.1530/acta.0.0670127

Cited by 16 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The lack of normal growth hormone responsiveness to insulin induced hypoglycemia in our patients is in agreement with that reported in the literature (Frantz et al, 1964;Hartog et al, 1964 , 1968;Strauch et al, 1969;Morrow et al, 1969;Werder et al 1971;Krieger and Glick, 1972;Demura et al, 1972;Werder et al, 1971) reported that the patients with hyper-adrenocorticism showed virtually no growth hormone elevation in response to the stress induced by hypoglycemia, behaving similar to dexamethoasone suppressed subjects. Stiel et al (1970) reported that normal subjects treated for 2 weeks with predonisolone in doses of 15 mg per day showed no significant diminution in their spontaneous plasma GH peaks and postulated that the chronicity, the constancy and the severity of glucocorticoid excess might all be the factors in abolishing the plasma GH peaks in Cushing's syndrome.…”

Section: Discussionsupporting

confidence: 92%

The Pituitary ACTH, GH, LH, FSH, TSH and Prolactin Reserves in Patients with Cushing's Syndrome

Hashimoto

1975

Endocrinol Japon

View full text Add to dashboard Cite

In order to know the pituitary reserves of ACTH, GH, LH, FSH, TSH and prolactin in patients with Cushing's syndrome, the responses of these hormones to hydrocortisone, lysine-8 vasopressin (LVP), insulin-induced hypoglycemia, luteinizing hormon-releasing hormone (LH-RH) and thyrotropin releasing hormone (TRH) were examined before and after treatment. Fourteen patients with Cushing's disease (adrenal hyperplasia), 3 patientswith adrenal adenoma and one patient with adrenal carcinoma were investigated. Before treatment, sufficient response of plasma ACTH to LVP was observed in patients with Cushing's disease, while no response was observed in 3 patients with adrenal adenoma. There was no significant difference in the responses of other pituitary hormones between the patients with Cushing's disease. and the patients with adrenal adenoma. The response of plasma GH to insulin-induced hypoglycemia was impaired in most these patients. The response of plasma TSH to TRH was impaired in 6 of 8 patients tested. The response of plasma LH and FSH to LH-RH were preserved in 6 and 5 of 8 patients, respectively. The response of plasma prolactin to TRH was normal in most patients tested. After treatment, the improvements of the impaired responses of GH, TSH, LH and FSH wereobserved. Therefore, the impaired reserve observed in these patients before treatment seemed to be due to the hypercortisolemia. If the difference of the suppressibility of these pituitary hormones by cortisol may be judged simply from our observation, the orderof the suppressibility is supposed to be ACTH, GH, TSH, LH and FSH, and then prolactin.

show abstract

Section: Discussionsupporting

confidence: 92%

The Pituitary ACTH, GH, LH, FSH, TSH and Prolactin Reserves in Patients with Cushing's Syndrome

Hashimoto

1975

Endocrinol Japon

View full text Add to dashboard Cite

show abstract

“…The absence of any such changes in subjects with pituitarydependent Cushing's syndrome has also been observed previously. The phenomenon has been attributed by some to an intrinsic hypothalamic defect of the disease (James, Landon, Wynn & Greenwood, 1968), and by others to adrenocortical overactivity (Werder, Smilo, Hane & Forsham, 1971). The latter view is supported by the recent observations of Besser, Cryer & Staub (1972) that such patients do show an in¬ crease of plasma ACTH concentration during insulin-induced hypoglycaemia after adrenalectomy.…”

Section: Discussionmentioning

confidence: 99%

Radioimmunoassay of Plasma Adrenocorticotrophin in Cushing's Syndrome

Croughs¹,

Tops²,

Jong³

1973

Journal of Endocrinology

View full text Add to dashboard Cite

The present study describes a radioimmunoassay for plasma adrenocorticotrophin (ACTH) in man with a sensitivity of at least 15 pg/ml.In-vitro studies using various fragments of ACTH showed immunobiological dissociation. However, this phenomenon does not appear to be of major importance in vivo, since stimulation and suppression tests showed overall parallel changes of immunoreactive plasma ACTH and plasma cortisol. The results obtained from patients with various forms of Cushing's syndrome are presented. It is concluded that basal plasma ACTH determinations are useful in the differential diagnosis of Cushing's syndrome and may help in predicting the development of a pituitary tumour after adrenalectomy.The supranormal plasma cortisol response to i.m. injection of lysinevasopressin in subjects with pituitary-dependent Cushing's syndrome is attributed both to an increased ACTH release by the pituitary and to an excessive response of the hyperplastic adrenal cortex. The i.v. infusion of dexamethasone at a rate of 1 mg/h for 5 h in subjects with pituitarydependent Cushing's syndrome was followed by significant and parallel decreases of both immunoreactive plasma ACTH and plasma cortisol. No rise of plasma ACTH levels was found with insulin-induced hypoglycaemia in subjects with untreated pituitary-dependent Cushing's syndrome.

show abstract

“…This inhibition can be overcome by the stress of surgery, which induces elevated cortisol blood levels despite general anesthesia (9). That halothane anesthesia interferes with steroid biosynthesis directly or enhances catabolism of steroids in the liver is unlikely, since patients with Cushing's syndrome and a fixed steroid output from their adrenal glands show a constant level of plasma 11-OHCS during general anesthesia (10).…”

mentioning

confidence: 99%

Adrenal Function During Long-Term Anesthesia in Man

Werder

Stevens

Cromwell

et al. 1970

Experimental Biology and Medicine

Self Cite

View full text Add to dashboard Cite

The present studies were designed to elucidate the effect of long-term general anesthesia with endoltracheal nitrous oxide and halothane upon adrenocortical and medullary function in man. Cortisol blood levels are known to increase in man during short-term general anesthesia without surgery ( 1 ) . However, cortisol secretion during long-term general anesthesia without additional surgery has not been studied. Cortisol release from the adrenal cortex is stimulated by pituitary ACTH, which in turn is activated by the hypothalamus via corticotropin releasing factor (CRF) ( 2 ) . An intricate negative feedback regulation between cortisol blood levels and the pituitary and hypothalamic centers keeps this system in balance ( 3 ) . The CRFproducing nerve cells are connected by neuronal synapses with higher brain centers (4). One might, therefore, assume that reduction of neocortical activity during general anesthesia would alter cerebro-hypothalamo-pituitary-adrenal function. However, it is surprising that the reduction in cortical activity of the brain should cause an increase rather than a decrease in cortisol blood levels.The present work suggests that, in fact, a decrease in adrenocortical activity does occur and that the increase previously found may be related to extraneous factors such as excitement during the second stage of anesthesia.Materials and Methods. Twelve healthy unrnedicated male volunteers (age 21 to 30 1 This paper was supported in part by U. S. Public Health Service Grants 1 PO1 GM15571-02 and 5T1 and the Levi J. and Mary Skaggs Foundation. Dr. Von Werder was in part supported by the Deutsche Forschungsgemeinschaft. 2Present address: I1 Klin. Med. Univ. Munich, Munich, Germany.years) were selected for study. In 5 subjects anesthesia was induced with 40 to 80% nitrous oxide (NzO) at approximately 9:30 a.m. After 10 to 15 min. halothane was added. The subjects' tracheae were intubated without the aid of muscle relaxants and the alveolar halothane concentration was adjusted to 0.5% with 70% nitrous oxide. The alveolar halothane was subsequently increased every 15 min to 1 and 1.5%. The subjects were then maintained on 1% alveolar halothane and 70% N20 for 3.5 hr, after which the halothane concentration was varied again in 15-min intervals (0.5, 1, 1.5, and 2%). No other stresses were imposed during the anesthesia. I n the remaining 7 subjects, N20 was omitted and general anesthesia was induced and maintained with halothane alone. After endotracheal intubation, the alveolar halothane concentration was maintained at 1.0 or 1.6%. Five percent glucose was slowly infused after onset of anesthesia to assure a constant blood glucose level during the procedure. In addition, the subjects who received only halothane were challenged with increasing endotracheal COz concentrations before and during the anesthesia to obtain cardiorespiratory CO2 responses. The results of these studies will be reported elsewhere. Of this group, one subject was infused with 1 mg of hydrocortisone succinate/hr anesthesia and the sec...

show abstract

Pituitary Response to Stress in Cushing's Disease

Cited by 16 publications

References 0 publications

The Pituitary ACTH, GH, LH, FSH, TSH and Prolactin Reserves in Patients with Cushing's Syndrome

The Pituitary ACTH, GH, LH, FSH, TSH and Prolactin Reserves in Patients with Cushing's Syndrome

Radioimmunoassay of Plasma Adrenocorticotrophin in Cushing's Syndrome

Adrenal Function During Long-Term Anesthesia in Man

Contact Info

Product

Resources

About