Plasma Adrenocorticotropin and Cortisol Responses to Ovine Corticotropin-Releasing Factor in Patients With Adrenocortical Insufficiency Due to Hypothalamic and Pituitary Disorders

Abstract

Plasma ACTH and cortisol responses to intravenous injection of 100 micrograms synthetic ovine corticotropin-releasing factor (CRF) were studied in 4 patients with hypothalamic hypopituitarism, 2 patients with Sheehan's syndrome, 2 patients with isolated ACTH deficiency and 10 normal subjects. All 4 patients with hypothalamic hypopituitarism had exaggerated plasma ACTH responses to CRF compared to normal subjects and gradual but definite increases in plasma cortisol from low basal levels. Of 2 patients with Sheehan's syndrome, one had slight ACTH and cortisol increases after CRF injection, whereas the other had no increase in either. In 2 patients with isolated ACTH deficiency, plasma ACTH and cortisol remained undetectable (ACTH less than 10 pg/ml, cortisol less than 0.6 microgram/dl) after CRF injection. These results suggest that the CRF test is a useful tool in evaluating patients with secondary adrenocortical deficiency.

Anterior Pituitary Function in Patients with Nonfunctioning Pituitary Adenoma: Results of Longitudinal Follow-up.

“…The criterion for cortisol in this study is essentially the same as the criterion used by other authors. In addition, we recommend introducing the corticotropin releasing hormone (CRH) test to evaluate ACTH secretion [16][17][18]. Because CRH stimulates the pituitary gland, we can evaluate pituitary-adrenal function irrespective of hypothalamic dysfunction.…”

“…Postoperative radiotherapy is useful in preventing tumor recurrence, and many authors have reported its effects [18][19][20][21], but it has been reported that patients receiving irradiation were at higher risk of impairment of anterior pituitary function [19,22,23]. According to these reports, many patients developed impairment of function within five years after irradiation and some lost anterior pituitary function 8 or 9 years after irradiation [23].…”

Corticotrophin Releasing Factor in Man and Its Measurement: A Review

“…A number of studies (Tsukada et al, 1984b;Shulte et al, 1984a;Hermus et al, 1985a) have demonstrated that a single intravenous bolus injection of CRF reveals two subgroups of patients with secondary adrenal failure. The first of these have a pronounced and prolonged ACTH response, often expressed as a biphasic pattern with a delayed second peak, indicating that the cause of the adrenal insufficiency is not in the pituitary gland itself, but originates in the hypothalmus or at a higher level within the brain.…”

A Case of Sheehan's Syndrome with Panhypopituitarism due to the Impairment of both the Hypothalamus and the Pituitary

“…Patients with the syndrome complain of symptoms resulting from the deficiency of multiple pituitary hormones. Hormonal examinations of those patients reveal that the site responsible for the deficiency of pituitary hormones is the pituitary itself [2][3][4][5][6][7].…”