pituitrin and Vertigo

Stress of some kind is encountered everyday and release of stress hormones is essential for adaptation to change. Stress can be physical (pain, noise exposure, etc.), psychological (apprehension to impending events, acoustic conditioning, etc.) or due to homeostatic disturbance (hunger, blood pressure, inner ear pressure, etc.). Persistent elevated levels of stress hormones can lead to disease states. The aim of the present review is to bring together data describing morphological or functional evidence for hormones of stress within the inner ear. The present review describes possible multiple interactions between the sympathetic and the complex feed-back neuroendocrine systems which interact with the immune system and so could contribute to various inner ear dysfunctions such as tinnitus, vertigo, hearing losses. Since there is a rapidly expanding list of genes specifically expressed within the inner ear this clearly allows for possible genomic and non-genomic local action of steroid hormones. Since stress can be encountered at any time throughout the life-time, the effects might be manifested starting from in-utero. These are avenues of research which remain relatively unexplored which merit further consideration. Progress in this domain could lead towards integration of stress concept into the overall clinical management of various inner ear pathologies.

Topics: Adrenal Cortex Hormones; Animals; Auditory Pathways; Biofeedback, Psychology; Ear; Hearing Loss; Hormones; Humans; Prolactin; Stress, Psychological; Sympathetic Nervous System; Tinnitus; Vasopressins; Vertigo

Meniere's disease, a common inner ear condition, has an incidence of 15-50 per 100,000. Because mental/physical stress and subsequent increase in the stress hormone vasopressin supposedly trigger Meniere's disease, we set a pilot study to seek new therapeutic interventions, namely management of vasopressin secretion, to treat this disease. We enrolled 297 definite Meniere's patients from 2010 to 2012 in a randomized-controlled and open-label trial, assigning Group-I (control) traditional oral medication, Group-II abundant water intake, Group-III tympanic ventilation tubes and Group-IV sleeping in darkness. Two hundred sixty-three patients completed the planned 2-year-follow-up, which included assessment of vertigo, hearing, plasma vasopressin concentrations and changes in stress/psychological factors. At 2 years, vertigo was completely controlled in 54.3% of patients in Group-I, 81.4% in Group-II, 84.1% in Group-III, and 80.0% in Group-IV (statistically I < II = III = IV). Hearing was improved in 7.1% of patients in Group-I, 35.7% in Group-II, 34.9% in Group-III, and 31.7% in Group-IV (statistically I < II = III = IV). Plasma vasopressin concentrations decreased more in Groups-II, -III, and -IV than in Groups-I (statistically I < II = III = IV), although patients' stress/psychological factors had not changed. Physicians have focused on stress management for Meniere's disease. However, avoidance of stress is unrealistic for patients who live in demanding social environments. Our findings in this pilot study suggest that interventions to decrease vasopressin secretion by abundant water intake, tympanic ventilation tubes and sleeping in darkness is feasible in treating Meniere's disease, even though these therapies did not alter reported mental/physical stress levels.. ClinicalTrials.gov NCT01099046.

Topics: Adult; Aged; Betahistine; Disease Management; Drinking; Female; Follow-Up Studies; Hearing Loss; Humans; Male; Meniere Disease; Middle Aged; Middle Ear Ventilation; Pilot Projects; Sleep; Treatment Outcome; Vasopressins; Vertigo

We examined whether sufficient water intake is effective in the long-term control of vertigo and hearing activity in patients with Meniere disease (MD) for whom conventional therapy has proven unsuccessful.. The authors conducted a time-series study with historical control.. Eighteen patients with MD in group 1 drank 35 mL/kg per day of water for 2 years. Twenty-nine patients with MD treated with the conventional dietary and diuretic therapy for more than 2 years during 1992 to 1999 at the same hospital were enrolled in a historical control of group 2.. Patients in group 1 dramatically relieved vertigo and significantly improved in the hearing of the worst pure-tone average of three frequencies (0.125, 0.25, and 0.5 kHz) (low PTA) during the last 6 months of the study period. In contrast, patients in group 2 became worse in both the four- (0.5, 1, 2, and 4 kHz) frequency PTA and the low PTA, although their vertigo did improve. The number of patients whose hearing were improved, unchanged, and worse were 4, 12, and 2 in group 1 and 2, 11, and 16 in group 2, respectively.. Deliberate modulation of the intake of water may be the simplest and most cost-effective medical treatment for patients with MD. Larger studies will be needed to confirm these results in a larger patient cohort.

Topics: Drinking; Female; Hearing Disorders; Humans; Male; Meniere Disease; Middle Aged; Vasopressins; Vertigo

Plasma antidiuretic hormone (p-ADH) and plasma osmolality (p-Osm) levels were studied in patients with Ménière's disease. In 147 cases, the p-ADH levels were measured during remission and in the acute phase of the disease. In 100 of 147 cases, the p-Osm levels were determined both in remission and in the acute phase. In remission, the p-ADH and p-Osm levels were higher than the normal limits. In the acute phase, the p-ADH level was higher than that in remission, consistent with previous reports. Moreover, the p-Osm level was unchanged. Although the p-ADH level is regulated by that of p-Osm, the kidney must show an escape phenomenon from antidiuresis. Besides, other factors must increase the amount of p-ADH. Further study is needed to reveal the cause of the rise in p-ADH and p-Osm levels.

Topics: Hearing; Humans; Male; Meniere Disease; Middle Aged; Osmolar Concentration; Recurrence; Severity of Illness Index; Vasopressins; Vertigo

There are some kinds of sicknesses provoked by inadequate adaptation to physical and/or psychogenic stress in daily life. Delayed endolymphatic hydrops (DEH) is an inner ear disease like Ménière's disease (MD) characterized by episodic vertigo in the setting of preexisting unilateral deafness that especially occurs in civilized people with a stressful lifestyle. Its otopathologic finding was demonstrated to be inner ear endolymphatic hydrops through a temporal bone study in 1976, as in the case with MD in 1938. To elucidate the relationship between stress and the inner ear, we examined the plasma antidiuretic stress hormone vasopressin (pAVP) and its type 2 receptor (V2R) expression in the endolymphatic sac in patients with DEH.. A prospective molecular biological study.. Between 1998 and 2007, we enrolled 20 patients with ipsilateral DEH to examine their pAVP during remission from vertigo attacks. Plasma vasopressin was also examined in 87 patients with unilateral MD and 30 control patients with chronic otitis media. Using the real-time polymerase chain reaction method with tissue samples obtained during surgery, we examined V2R mRNA expression in the endolymphatic sac in 6 patients with ipsilateral DEH, 9 patients with unilateral MD, and 6 control patients with acoustic neuroma.. Plasma vasopressin (1.5 times versus controls; unpaired t test, p = 0.140) and V2R mRNA expression in the endolymphatic sac (35.8 times versus controls; unpaired t test, p = 0.002) were higher in patients with DEH compared with those with acoustic neuroma. There were no significant differences in pAVP or V2R expression in the endolymphatic sac between DEH and MD. Patients with DEH showed a significantly negative correlation between pAVP and V2R (Pearson test, r = -0.92, p = 0.009) as in those with MD (Pearson test, r = -0.68, p = 0.043).. Civilized people are frequently exposed to stress in their daily life, and pAVP can easily become elevated at any time. Therefore, a negative feedback system between pAVP and V2R in the endolymphatic sac may function for inner ear fluid homeostasis against stress-induced increases in pAVP. For the pathogenesis of endolymphatic hydrops resulting in vertigo attacks in patients with DEH as well as MD, pAVP may represent a matter of consequence, but V2R overexpression in the endolymphatic sac could be much more essential as a basis for these diseases.

Topics: Adult; Blotting, Western; Data Interpretation, Statistical; Endolymphatic Hydrops; Endolymphatic Sac; Female; Humans; Male; Meniere Disease; Middle Aged; Otologic Surgical Procedures; Prospective Studies; Receptors, Vasopressin; Reverse Transcriptase Polymerase Chain Reaction; RNA; Vasopressins; Vertigo

An elevation of the plasma antidiuretic hormone (ADH) levels has frequently been observed in Meniere's disease patients. However, little is known regarding the mechanism behind such an elevation of ADH level in Meniere's disease patients. Therefore, we measured the plasma ADH in Meniere's disease patients and other vertigo patients to elucidate the association between the ADH levels, stress levels and the development of Meniere's symptom.. The plasma ADH levels and plasma osmotic pressure were determined in 23 definite Meniere's disease patients and 160 patients with other types of vertigo/dizziness. All participants were administered questionnaire regarding their psychological status including their stress levels.. The ADH levels of Meniere's disease patients in the acute phase (5.80 +/- 1.37 pg/mL) were significantly higher in comparison with that of Meniere's disease patients in the remission phase (2.26 +/- 0.41 pg/mL) (P < 0.05). In other peripheral vertigo patients, the ADH level in the acute phase (1.71 +/- 0.23 pg/mL) was not significantly different from that in the remission phase (1.45 +/- 0.15 pg/mL). Meniere's disease patients in the acute phase had a significantly higher stress score (114 +/- 23) than Meniere's disease patients in the remission phase (56 +/- 13) (P < 0.05). However, there was no significant correlation between their stress score and the ADH levels.. These results suggest that the elevation of the plasma ADH levels in Meniere's disease patients in the acute phase is, therefore, associated with the pathogenesis of Meniere's disease attacks rather than with stress.

Topics: Acute Disease; Adult; Aged, 80 and over; Depression; Dizziness; Female; Humans; Life Change Events; Male; Meniere Disease; Middle Aged; Osmotic Pressure; Remission, Spontaneous; Sex Factors; Stress, Psychological; Vasopressins; Vertigo

We studied the relation between psychosomatic profiles of patients with Menière's disease and antidiuretic hormone (ADH). For investigation of the psychosomatic aspects, we used the Cornell Medical Index (CMI), Yatabe-Guilford personality (Y-G) test and the originally produced stress questionnaire. In Y-G test, patients with Menière's disease are classified in normal group. In the CMI test, on the other hand, types III and IV were significantly more often observed in Menière's disease than normal control (chi 2 test, p < 0.05). However, the CMI test results have no correlation to plasma ADH (p-ADH) levels. The survey of our original questionnaire revealed that stress has a close relationship to vertiginous attacks. Further, high p-ADH levels were significantly frequently observed in cases with stress compared with cases without stress (t-test, p < 0.05).

Topics: Adult; Aged; Cornell Medical Index; Female; Humans; Male; Meniere Disease; Middle Aged; Personality; Personality Tests; Psychophysiologic Disorders; Stress, Physiological; Stress, Psychological; Surveys and Questionnaires; Vasoconstrictor Agents; Vasopressins; Vertigo

Plasma antidiuretic hormone (p-ADH) concentrations were determined with a radioimmunoassay, using a reversed-phase C18 silica column, in 300 patients with vertigo, dizziness and/or deafness; 119 of them had a diagnosis of Menière's disease. The p-ADH level was significantly elevated in patients with Meniere's disease and others with endolymphatic hydrops, e.g. cochlear Menière's disease or delayed hydrops. By contrast, the p-ADH level was not so high in cases without the endolymphatic hydrops. The increase in the p-ADH level was closely linked to vertigo attacks, the glycerol test results and an enhanced negative summating potential (-SP) in electrocochleogram (ECochG). These results lead to the assumption that disorders of ADH-dependent hormonal control in the inner ear may constitute the possible mechanism underlying vertiginous attacks and deafness in patients with endolymphatic hydrops.

Topics: Cochlea; Deafness; Dizziness; Edema; Electrophysiology; Endolymphatic Hydrops; Glycerol; Heating; Humans; Meniere Disease; Vasopressins; Vertigo