Inferior petrosal sinus sampling in healthy subjects reveals a unilateral corticotropin-releasing hormone-induced arginine vasopressin release associated with ipsilateral adrenocorticotropin secretion.

Kalogeras, Konstantine T.; Nieman, Lynnette K.; Friedman, Theodore C.; Doppman, John L.; Cutler, Gordon B.; Chrousos, George P.; Wilder, Ronald L.; Gold, Philip W.; Yanovski, Jack A.

doi:10.1172/jci118640

Cited by 73 publications

(38 citation statements)

References 55 publications

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“…We have found evidence of the lateralization of neuroendocrine function as well. 63 It is of potential interest that the most replicated neuroimaging results in depression are those showing abnormalities in the left amygdala and left subgenual prefrontal cortex. Mayberg has advanced data that nicely illustrate bidirectionally the reciprocity between cortical and subcortical sites and suggest that the reciprocity between these sites is immediate and obligatory.…”

Section: The Prefrontal Cortexmentioning

confidence: 99%

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

2002

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Stress precipitates depression and alters its natural history. Major depression and the stress response share similar phenomena, mediators and circuitries. Thus, many of the features of major depression potentially reflect dysregulations of the stress response. The stress response itself consists of alterations in levels of anxiety, a loss of cognitive and affective flexibility, activation of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system, and inhibition of vegetative processes that are likely to impede survival during a life-threatening situation (eg sleep, sexual activity, and endocrine programs for growth and reproduction). Because depression is a heterogeneous illness, we studied two diagnostic subtypes, melancholic and atypical depression. In melancholia, the stress response seems hyperactive, and patients are anxious, dread the future, lose responsiveness to the environment, have insomnia, lose their appetite, and a diurnal variation with depression at its worst in the morning. They also have an activated CRH system and may have diminished activities of the growth hormone and reproductive axes. Patients with atypical depression present with a syndrome that seems the antithesis of melancholia. They are lethargic, fatigued, hyperphagic, hypersomnic, reactive to the environment, and show diurnal variation of depression that is at its best in the morning. In contrast to melancholia, we have advanced several lines of evidence of a down-regulated hypothalamic-pituitary adrenal axis and CRH deficiency in atypical depression, and our data show us that these are of central origin. Given the diversity of effects exerted by CRH and cortisol, the differences in melancholic and atypical depression suggest that studies of depression should examine each subtype separately. In the present paper, we shall first review the mediators and circuitries of the stress system to lay the groundwork for placing in context physiologic and structural alterations in depression that may occur as part of stress system dysfunction. Molecular Psychiatry (2002) 7, 254-275. DOI: 10.1038/sj/mp/4001032 Keywords: atypical depression; corticotropin releasing hormone (CRH); melancholic depression; norepinephrine (NE); stress Stress precipitates major depression and influences its incidence, severity and course. 1,2 The stress response and major depression share many features because of similar brain circuitries and mediators (reviewed in 3-5 ). Each is associated with a diminution of cognitive and affective flexibility, alterations in arousal, and perturbations in neuroendocrine and autonomic function (reviewed in 5 ). Because major depression is a heterogeneous disorder, we focus here on two subtypes, melancholic and atypical depression. Our data and those of others indicate that the principal arousal producing mediators of the stress response, such as the corticotropin releasing hormone (CRH) system, are hyperactive in melancholic depression. 6 Not surprisingly, melan- cholia is associated with anxiety, dread of the ...

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Section: The Prefrontal Cortexmentioning

confidence: 99%

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

2002

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“…The hypersecretion of ADH seen in cortisol deficiency is due to increase in hypothalamic secretion of corticotropin-releasing hormone (CRH) and may be due in part to the reduction in systemic blood pressure and cardiac output (mechanism unknown). 5 The mechanism of rhabdomyolysis due to hyponatremia is thought to be a result of hypo-osmolality of extracellular fluid causing myocytes swelling. This leads to extrusion of intracellular potassium leading to its depletion in myocytes.…”

Section: Discussionmentioning

confidence: 99%

Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

et al. 2017

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“…Further, lateralisation of secretion of ACTH, arginine vasopressin and oxytocin is seen in the petrosal sinus of normal volunteers. ACTH and arginine vasopressin responses to CRH were similarly lateralised, implying the normal occurrence of asymmetry in the concentrations of ACTH in the petrosal sinus (40). Lateralisation may not be so important as the cure rate is unaffected by the nature and extent of the pituitary lesion or the surgical procedure used (41).…”

Section: Journal Of Endocrinology (1998) 139mentioning

confidence: 97%

Bilateral sequential inferior petrosal sinus sampling with corticotrophin-releasing hormone stimulation in the diagnosis of Cushing's disease

Padayatty

Orme²,

Nelson³

et al. 1998

European Journal of Endocrinology

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Objective: The demonstration of a central to peripheral ACTH gradient in a hypercortisolaemic patient is diagnostic of Cushing's disease. We tried to determine whether single blood samples for ACTH obtained sequentially from each of the inferior petrosal sinuses following human corticotrophin-releasing hormone (hCRH) stimulation can reliably establish such a gradient. Design: Prospective study. Patients: Seventeen patients with clinical and biochemical features of Cushing's syndrome. Methods: After the administration of hCRH, the patients underwent bilateral sequential inferior petrosal sinus sampling, with a single blood sample obtained from each of the inferior petrosal sinuses sequentially, along with a peripheral venous sample. The petrosal sinus catheter was withdrawn immediately after obtaining a blood sample. Patients did not require indwelling catheters in the petrosal sinuses, nor heparinisation. Results: Bilateral sequential inferior petrosal sinus sampling correctly identified a pituitary source of ACTH, as shown by a central to peripheral ACTH ratio >2, in all patients in whom the procedure was successfully carried out. All patients underwent transsphenoidal pituitary surgery resulting in remission. Conclusions: The simplified method of inferior petrosal sinus sampling, using a single sequential sample from each of the inferior petrosal sinuses, following initial hCRH stimulation, is as accurate as the more complex test using multiple bilateral simultaneous inferior petrosal sinus samples. It avoids the use of indwelling cerebral venous catheters and is therefore unlikely to cause brain stem damage.

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Inferior petrosal sinus sampling in healthy subjects reveals a unilateral corticotropin-releasing hormone-induced arginine vasopressin release associated with ipsilateral adrenocorticotropin secretion.

Cited by 73 publications

References 55 publications

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states

Addisonian crisis complicated by rhabdomyolysis and acute kidney injury

Bilateral sequential inferior petrosal sinus sampling with corticotrophin-releasing hormone stimulation in the diagnosis of Cushing's disease

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