pituitrin and Acromegaly

Topics: Acromegaly; Adrenocorticotropic Hormone; Animals; Blood Glucose; Calcitonin; Carcinoma, Small Cell; Cell Transformation, Neoplastic; Chorionic Gonadotropin; Corticotropin-Releasing Hormone; Cushing Syndrome; Dexamethasone; Female; Galactorrhea; Gene Expression Regulation; Growth Hormone; Humans; Hypercalcemia; Lymphokines; Nerve Tissue Proteins; Paraneoplastic Endocrine Syndromes; Parathyroid Hormone; Peptide Biosynthesis; Pregnancy; Pro-Opiomelanocortin; Prolactin; Prostaglandins; Transforming Growth Factors; Vasopressins; Vitamin D

The 41-amino acid CRF fulfils all the criteria for a corticotrophin releasing factor, although considerable evidence suggests that other factors, particularly VP, also play a physiologically significant role in controlling ACTH release. Although human CRF has now been identified as a 41-residue peptide, most studies to date have used oCRF-41 in their exploration of the physiology and pathology of the hypothalamic--pituitary--adrenal axis. Low doses of oCRF-41 appear to be safe, and for specific tests of the readily-releasable pool of ACTH and related peptides 100 micrograms is a practical dose for most purposes. Although serious side-effects have only been noted at doses above 100 micrograms, it is reasonable to monitor all patients administered CRF-41 with great care, and in particular to be alert to hypotension, especially in patients with corticosteroid deficiency. There is little doubt that, in combination with the standard insulin-tolerance test, the CRF test is a useful means of diagnosing hypothalamic or portal dysfunction in patients with secondary adrenal failure. However, in the diagnosis and differential diagnosis of Cushing's syndrome, the role of the CRF test remains unclear. In normal subjects, a high basal cortisol level usually inhibits the response to CRF, such that a greatly enhanced response is suggestive of pituitary-dependent Cushing's syndrome. In patients with diagnosed ACTH-dependent Cushing's syndrome, an absent response to CRF predisposes towards an ectopic source of ACTH. However, there are exceptions in all directions, and it is uncertain whether the CRF test will prove of greater value than the traditional procedures, such as the dexamethasone suppression test. The differential diagnosis of depression and Cushing's disease may be its greatest value. In terms of treatment, there are as yet few data on the usefulness of CRF in expediting recovery of the pituitary-adrenal axis following long-term suppression, such as in patients with Cushing's syndrome treated by removal of a unilateral adenoma or trans-sphenoidal microadenomectomy. It is possible that such treatment may eventually be a useful application of CRF, although data are not yet available.

Topics: Acetylcholine; Acromegaly; Adrenocorticotropic Hormone; Animals; Circadian Rhythm; Corticotropin-Releasing Hormone; Cushing Syndrome; Depressive Disorder; Diagnosis, Differential; Growth Hormone; Humans; Hypothalamo-Hypophyseal System; Immunologic Techniques; Kinetics; Models, Biological; Pituitary-Adrenal System; Stress, Physiological; Vasopressins

Topics: Acromegaly; Adrenal Glands; Blood Glucose; Brain Diseases; Calcium; Dwarfism; Gigantism; Glucose Tolerance Test; Growth Hormone; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Hypothalamus; Insulin; Lysine; Phosphates; Pituitary Diseases; Pneumoencephalography; Prolactin; Radioimmunoassay; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins; Water Deprivation

Topics: Acromegaly; Cushing Syndrome; Diabetes Insipidus; Gigantism; Humans; Hypopituitarism; Hypothalamo-Hypophyseal System; Pituitary Diseases; Pituitary Gland, Posterior; Vasopressins

Topics: Acromegaly; Addison Disease; Adult; Central Nervous System Diseases; Diabetes Insipidus; Humans; Hyperthyroidism; Hypothyroidism; Kidney; Lung Diseases; Male; Neoplasms; Pituitary Diseases; Thyroid Diseases; Vasopressins

Topics: Acromegaly; Addison Disease; Adrenocortical Hyperfunction; Cushing Syndrome; Diabetes Insipidus; Endocrine System Diseases; Humans; Hyperaldosteronism; Hyperparathyroidism; Hypopituitarism; Hypothyroidism; Kidney; Vasopressins; Water-Electrolyte Balance

Topics: Acromegaly; Adult; Arginine; Blood; Clinical Trials as Topic; Cortisone; Dehydration; Dexamethasone; Diethylstilbestrol; Diuresis; Female; Growth Hormone; Humans; Male; Middle Aged; Nicotine; Osmolar Concentration; Pituitary Function Tests; Pituitary Gland, Posterior; Urine; Vasopressins

Topics: 17-Hydroxycorticosteroids; Acromegaly; Adenoma, Chromophobe; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Brain Diseases; Central Nervous System Diseases; Clinical Trials as Topic; Craniocerebral Trauma; Diabetes Insipidus; Female; Humans; Hypothalamo-Hypophyseal System; Intracranial Pressure; Male; Metyrapone; Pituitary Diseases; Pituitary Function Tests; Pituitary Neoplasms; Pseudotumor Cerebri; Vasopressins

Gangliocytomas or gangliogliomas of the sellar region are very rare tumors. In a great proportion of those cases an adenoma of the anterior pituitary develops from the cell type that is hyperstimulated by the releasing hormone produced from the gangliocytoma. Five GHRH secreting gangliocytomas are reported. Four of these were localized adjacent to a GH secreting adenoma. In one case, no adenoma tissue was found beside the ganglicytoma. As only the adenomas can secrete GH, the adenomas and not the gangliocytomas are directly responsible for acromegaly so that such an adenoma has to be present in cases of acromegaly. A CRH secreting gangliocytoma was combined with an ACTH cell adenoma that had induced Cushing's disease. A ganglioglioma of the posterior pituitary had led to an inappropriate secretion of Vasopressin. The morphology of the different tumors is presented.

Topics: Acromegaly; Adenoma; Adult; Aged; Child; Female; Ganglioneuroma; Growth Hormone-Releasing Hormone; Human Growth Hormone; Humans; Male; Middle Aged; Pituitary Neoplasms; Sella Turcica; Vasopressins

Topics: Acromegaly; Adolescent; Adrenal Gland Diseases; Adult; Animals; Calcitonin; Corticotropin-Releasing Hormone; Enkephalins; Female; Gastrointestinal Hormones; Growth Hormone-Releasing Hormone; Humans; Hypothalamic Hormones; Male; Middle Aged; Nerve Tissue Proteins; Neurotransmitter Agents; Pancreas; Pituitary Hormone-Releasing Hormones; Secretin; Somatostatin; Vasopressins

While pituitary tumors are not as rare as was once thought, it is difficult to assess how many are of clinical significance. Trans-sphenoidal pituitary exploration is a technique which can be performed with low operative morbidity and mortality, and when instituted early can prevent subsequent visual and endocrine impairment from an expanding lesion. Thus early recognition has increased importance.

Topics: Acromegaly; Adenoma; Adenoma, Chromophobe; Adrenocorticotropic Hormone; Adult; Cushing Syndrome; Female; Follicle Stimulating Hormone; Growth Hormone; Humans; Luteinizing Hormone; Male; Middle Aged; Pituitary Neoplasms; Prolactin; Thyrotropin; Vasopressins

Fourteen patients with acromegaly were treated with bromocryptine (CB 154, Sandoz), 4 X 2.5 mg, for periods of up to eleven months. One patient did not tolerate the drug, ten of the remaining thirteen experienced considerable clinical improvement. There was a dose-dependent suppression of plasma growth hormone levels, but growth hormone response to TRH injection and to glucose administration was still present during therapy although reduced. TSH response to TRH was not significantly altered. The suppressive power of bromocryptine on growth hormone appears to be related to the mechanism by which TRH stimulates growth hormone secretion in acromegaly, but long-term administration of this drug may be successful in spite of an absent response to TRH in some cases. Bromocryptine appears to be a safe and effective drug for the treatment of acromegaly.

Topics: Acromegaly; Adrenocorticotropic Hormone; Adult; Aged; Bromocriptine; Diet; Ergolines; Female; Follicle Stimulating Hormone; Glucose; Glucose Tolerance Test; Growth Hormone; Humans; Luteinizing Hormone; Male; Middle Aged; Thyrotropin; Thyrotropin-Releasing Hormone; Time Factors; Vasopressins

The development of a sensitive and specific radioimmunoassay for vasopressin is described. Antibodies were successfully produced following the coupling of synthetic arginine vasopressin with bovine serum albumin carried out with carbodiimide. In order to standardize the assay, the labelled hormone has to be separated twice using a DEAE-Sephadex-A-25 column and thin layer chromatography with cellulose plates. A further condition to obtain a reproducible standard curve is the use of a pure arginine vasopressin checked by cellulose chromatography. Most of the vasopressin batches available do not fulfil this requirement of purity. With the method described, vasopressin can be determined in unextracted human urine. The lower limit of detection is 2 pg/ml. Normal values are in the range of 67.5 +/- 34.3 ng/24 h (kappa +/- SD, n =45). No significant difference of AVP excretion was found between men and women. The usefulness of the assay is demonstrated in patients with hypothalamic or pituitary disorders.

Topics: Acromegaly; Adolescent; Adult; Aged; Arginine Vasopressin; Breast Neoplasms; Child; Chromatography, Thin Layer; Cushing Syndrome; Diabetes Insipidus; Female; Humans; Immune Sera; Immunodiffusion; Lypressin; Male; Middle Aged; Prostatic Neoplasms; Radioimmunoassay; Vasopressins

The development of radioimmunoassay by the late Solomon A. Berson and Rosalyn S. Yalow during the late 1950s represents a milestone in the history of the application of radionuclide methodology to biology and to medical investigation and practice. The method offers a technique to assay materials otherwise unmeasureable or detectable only with difficulty. Radioimmunoassay is based upon the competition between labeled and unlabeled antigen for specific antibody sites, forming antigen-antibody complexes. This reaction is described by the expression see journal for formula. At equilibirum, the radioactive complex (bound) is separated from the radioactive antigen (free). The B/F ratio is dependent upon the amount of nonradioactive antigen. Antigen concentration in unknown samples is determined by comparing the B/F ratio to the B/F ratios obtained by incubating varying amounts of known nonradioactive antigen with the same amount of antibody as in the unknown sample under similar assay conditions. Sensitivity of the order of 10-12 moles/liter may be achieved through the preparation and use of a labeled antigen of high specific activity and the production and selection of antisera with appropriately high affinity constants. Specificity is dependent upon the ability of the antiserum to recognize subtle structural features of the antigen molecule. The ability to conveniently assay large numbers of samples with good precision has led to the application of this technique to quantitate substances (such as steroids) already measurable but by more cumbersome methods. Since the initial description of competitive binding radioassay techniques, there have been numerous contributions to its further development, refinement, and application. This article reviews the conception and development of this invaluable contribution to our understanding of health and disease.

Topics: Acromegaly; Adrenocorticotropic Hormone; Amino Acid Sequence; Binding, Competitive; Calcitonin; Cell Membrane; Cross Reactions; Cytosol; Dose-Response Relationship, Drug; Female; Gastrins; Gonadotropins; Growth Hormone; Humans; Immune Sera; Insulin; Iodine Radioisotopes; Isotope Labeling; Male; Oxytocin; Parathyroid Hormone; Pregnancy; Proinsulin; Prolactin; Radioimmunoassay; Receptors, Cell Surface; Thyrotropin; Vasopressins

Topics: Acromegaly; Addison Disease; Adrenalectomy; Blood Glucose; Cushing Syndrome; Diabetes Insipidus; Dwarfism; Dwarfism, Pituitary; Female; Glucagon; Growth Hormone; Humans; Hyperthyroidism; Hypogonadism; Hypopituitarism; Insulin; Lysine; Male; Pyrogens; Radioimmunoassay; Vasopressins

Topics: Acromegaly; Adenoma, Acidophil; Adenoma, Chromophobe; Adult; Brain Neoplasms; Craniopharyngioma; Diabetes Insipidus; Female; Humans; Luteinizing Hormone; Male; Meningioma; Metyrapone; Pinealoma; Pituitary Hormone-Releasing Hormones; Pituitary Neoplasms; Radioimmunoassay; Thyrotropin; Thyrotropin-Releasing Hormone; Vasopressins

Topics: 17-Hydroxycorticosteroids; Acromegaly; Adenoma, Chromophobe; Adolescent; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Child; Craniopharyngioma; Dexamethasone; Humans; Hypoglycemia; Hypothalamus; Insulin; Lysine; Metyrapone; Middle Aged; Pituitary Gland; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Pyrogens; Sella Turcica; Vasopressins

Topics: Acromegaly; Edema; Endocrine System Diseases; Humans; Hyperaldosteronism; Hyperthyroidism; Hyponatremia; Hypothyroidism; Syndrome; Vasopressins

Topics: Acromegaly; Adenoma, Chromophobe; Craniopharyngioma; Female; Headache; Humans; Hypogonadism; Insulin; Iodine Radioisotopes; Male; Metyrapone; Optic Atrophy; Osteoporosis; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Skull Neoplasms; Thyroid Function Tests; Vasopressins; Vision Disorders

Topics: Acromegaly; Adrenal Glands; Adult; Aged; Cushing Syndrome; Female; Fever; Glucocorticoids; Growth Hormone; Humans; Hypothalamus; Insulin; Male; Metyrapone; Middle Aged; Pituitary Diseases; Pituitary Gland; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Acromegaly; Adenoma; Adolescent; Adrenal Gland Neoplasms; Adrenocorticotropic Hormone; Adult; Anorexia Nervosa; Brain Diseases; Brain Neoplasms; Cushing Syndrome; Endocrine System Diseases; Female; Humans; Hydrocortisone; Hypothalamus; Injections, Intramuscular; Lysine; Male; Metyrapone; Middle Aged; Pituitary Neoplasms; Pituitary-Adrenal Function Tests; Vasopressins

Topics: Acromegaly; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Dexamethasone; Diabetes Mellitus; Dysautonomia, Familial; Dyspepsia; Female; Goiter; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Lysine; Male; Middle Aged; Vasopressins

Topics: Acromegaly; Animals; Epinephrine; Glucose Tolerance Test; Growth Hormone; Haplorhini; Humans; Hypoglycemia; Hypothalamo-Hypophyseal System; Models, Biological; Pituitary Gland; Prochlorperazine; Temperature; Umbilical Cord; Vasopressins

Topics: Acromegaly; Adult; Aged; Breast Neoplasms; Cushing Syndrome; Diabetes Insipidus; Diabetic Retinopathy; Female; Humans; Male; Middle Aged; Pituitary Gland; Polyuria; Prostatic Neoplasms; Ultrasonic Therapy; Vasopressins