A Cyproheptadine-Reversible Defect in ACTH Control Persisting after Removal of the Pituitary Tumor in Cushing's Disease
- 19 November 1981
- journal article
- research article
- Published by Massachusetts Medical Society in New England Journal of Medicine
- Vol. 305 (21), 1244-1248
- https://doi.org/10.1056/nejm198111193052103
Abstract
We studied two phases of cortisol feedback suppression of ACTH in nine patients who had had adrenalectomy for Cushing's disease. Four had been treated by adrenalectomy alone and presumably had ACTH-secreting pituitary tumors. Five others were studied two or more years after transsphenoidal removal of an ACTH-secreting microadenoma. In both groups, cortisol-ACTH feedback during the first 30 minutes of cortisol infusion was abnormal; plasma ACTH fell only 2.7±2.6 per cent (mean ±S.E.), as compared with 28.0±10.1 per cent in five hypoadrenal controls (P<0.01). The fall in ACTH during the second phase of cortisol infusion was similar in the patients and the controls. Cyproheptadine corrected the feedback abnormality occurring during the first phase in both groups of patients with Cushing's disease; ACTH fell by 24.4±4.8 per cent (P<0.005). Persistence of a cortisol-ACTH feedback abnormality after removal of the pituitary tumor in Cushing's disease, as well as the correction by cyproheptadine, suggests that higher centers have a role in the pathophysiology of Cushing's disease. (N Engl J Med. 1981; 305:1244–8.)This publication has 26 references indexed in Scilit:
- A Cyproheptadine-Reversible Defect in ACTH Control Persisting after Removal of the Pituitary Tumor in Cushing's DiseaseNew England Journal of Medicine, 1981
- Cushingʼs Disease—18 Yearsʼ ExperienceMedicine, 1981
- Sustained Remission of Nelson's Syndrome after Stopping Cyproheptadine TreatmentNew England Journal of Medicine, 1980
- Positive Rate-Sensitive Corticosteroid Feedback Mechanism of ACTH Secretion in Cushing's DiseaseJCI Insight, 1979
- THE EFFECT OF CYPROHEPTADINE ON THE RELEASE OF CORTICOTROPHIN RELEASING FACTORClinical Endocrinology, 1979
- Cushing's DiseaseNew England Journal of Medicine, 1978
- Paradoxical ACTH Response to Glucocorticoids in Cushing's DiseaseNew England Journal of Medicine, 1977
- SEROTONIN REGULATION OF ACTH SECRETIONAnnals of the New York Academy of Sciences, 1977
- Plasma Immunoassayable ACTH Levels during and after Hydrocortisone Infusion in Patients with Cushing's DiseaseEndocrinologia Japonica, 1976
- EVIDENCE FOR DUAL CORTICOSTEROID-RECEPTOR MECHANISMS IN THE FEEDBACK CONTROL OF ADRENOCORTICOTROPHIN SECRETIONJournal of Endocrinology, 1974