Clinical features of adrenal steroid deficiency occur in patients with the acquired immunodeficiency syndrome (AIDS). To determine the frequency of aberrations in peripheral steroid levels in patients with AIDS and AIDS-related complex (ARC) we measured morning recumbent plasma cortisol, deoxycorticosterone, 18-hydroxydeoxycorticosterone (18-OHDOC), corticosterone, aldosterone, and 18-hydroxycorticosterone concentrations before and after administration of 0.25 mg ACTH (Cosyntropin) in 74 randomly selected hospitalized patients with AIDS and 19 patients with ARC. Basal (0800 h) cortisol levels in the AIDS patients were significantly higher (P less than 0.01) than those in normal subjects, while other ACTH-dependent steroids of the 17-deoxypathway, deoxycorticosterone, corticosterone, and 18-OHDOC, were normal. These latter steroids increased subnormally in response to ACTH in patients with either AIDS (P less than 0.001) or ARC (P less than 0.005), but in ARC patients plasma 18-OHDOC levels were significantly higher than in those with AIDS (P less than 0.001). Supraphysiological doses of ACTH were then administered for 3 consecutive days to 14 patients with AIDS and 9 with ARC, which confirmed and amplified the subnormal responses of these steroids in AIDS. The mean plasma cortisol response was reduced on the third day only in AIDS patients, whereas in the ARC patients the steroid responses were normal. Angiotensin III infusion and postural stimulation increased plasma aldosterone and 18-hydroxycorticosterone levels in AIDS and ARC patients. Defective stimulation of 18-OHDOC alone or in combination with defective stimulation of other 17-deoxysteroids can be a harbinger of subsequent impaired adrenal capacity in AIDS.

Calcium and other divalent cations rapidly increase intracellular free Ca2+ ([Ca2+]i) in bovine parathyroid cells and inhibit PTH release. In other secretory cells, agonist-dependent generation of inositol trisphosphate (InsP3) through polyphosphoinositide turnover initiates the rise in [Ca2+]i by mobilizing Ca2+ from intracellular stores. To determine whether polyphosphoinositide breakdown is involved in mediating the response to Ca2+ and the divalent cations Ba2+, Mn2+, and Sr2+, we measured the production of inositol polyphosphates in parathyroid cells. Within 120 sec of increasing extracellular Ca2+ to 2.0 mM, InsP3, inositol bisphosphate (InsP2), and inositol monophosphate (InsP1) rose 95 +/- 37%, 87 +/- 17%, and 96 +/- 29%, respectively, vs. values in cells at 0.5 mM Ca2+ (n = 5). Raising extracellular Ca2+ from 0.5-3.0 mM produced even greater peak increments of 134 +/- 13%, 179 +/- 35%, and 313 +/- 65% in InsP3, InsP2, and InsP1, respectively, by 120 sec (n = 4). Similarly, within 10 sec of their addition, BaCl2 (2 mM), MnCl2 (2 mM), and SrCl2 (4 mM) stimulated the production of InsP3 56 +/- 2%, 152 +/- 31%, and 160 +/- 25%, respectively, vs. that in untreated cells at 0.5 mM Ca2+. At later time points, InsP2 and InsP1 were increased. The Ca2+ ionophore ionomycin at concentrations up to 500 nM had no effect on inositol phosphates, although it inhibited PTH release in a dose-dependent manner. Since high Ca2+ and other divalent cations depolarize parathyroid cells, we assessed the effect of high extracellular K+ on inositol polyphosphates. The addition of depolarizing concentrations of K+ (40 mM) did not change inositol phosphates. Thus, Ca2+ and other divalent cations increase the production of InsP3, InsP2, and InsP1 in parathyroid cells by a mechanism independent of increases in [Ca2+]i and of membrane depolarization. We conclude that parathyroid cells express membrane receptors or sensors for Ca2+ and other divalent cations linked to polyphosphoinositide turnover.

High extracellular Ca2+ stimulates the accumulation of inositol trisphosphate and diacylglycerol in parathyroid cells and suppresses PTH release. Since diacylglycerol is an endogenous activator of protein kinase-C, these observations would suggest that activation of protein kinase-C is associated with inhibition of PTH release. However, phorbol esters, which stimulate protein kinase-C activity, have been reported to enhance PTH release. To clarify the role of protein kinase-C in the regulation of PTH secretion, we studied the responses of parathyroid cells to phorbol myristate acetate (PMA), bryostatin-1, and 1,2-dioctanoylglycerol (diC8). PMA and bryostatin-1 translocated protein kinase-C activity from the soluble to particulate fractions of cell homogenates. Phosphotransferase activity in the particulate fractions increased from 21 +/- 4% to 93 +/- 6% of the total activity after 10 min of exposure to PMA (10(-6) M) and from 21 +/- 2% to 69 +/- 2% after 5 min of exposure to bryostatin-1 (10(-7) M). These three structurally different agonists of protein kinase-C also altered the typical secretory response to Ca2+ in parathyroid cells. At 2.0 mM extracellular Ca2+, PMA (10(-6) M) bryostatin-1 (10(-7) M), and 1,2-dioctanoylglycerol (3 x 10(-4) M) blunted the suppressive effects of high Ca2+ on secretion, thus stimulating PTH release 252 +/- 45%, 122 +/- 20%, and 485 +/- 95% over control levels, respectively. However, at low extracellular Ca2+, these agents inhibited maximal PTH release. Since changes in the intracellular free Ca2+ concentration ([Ca2+]i) may be important in the control of PTH release, we investigated whether protein kinase-C agonists changed the relationship between extracellular Ca2+ and PTH release by affecting [Ca2+]i. In PMA-treated cells, the intracellular Ca2+ response to raising extracellular Ca2+ from 0.5 to 1.5 and 2.0 mM was reduced to 50 +/- 1% and 63 +/- 3% of that in control cells, respectively (P less than 0.005; n = 7-11). Specifically, PMA preincubation reduced the initial intracellular Ca2+ transient with raising extracellular Ca2+ from 0.5 to 2.0 mM and with adding 4.0 mM Sr2+. The sustained phase response to high Ca2+, but not to Sr2+, was also attenuated after incubation with PMA. We conclude that protein kinase-C agonists suppress PTH release at low extracellular Ca2+ and enhance PTH release at high extracellular Ca2+. The effects on secretion at high extracellular Ca2+ may be related to the ability of protein kinase-C agonists to change the sensitivity of [Ca2+]i to high extracellular Ca2+ in these cells.