COMPARISON OF EFFECTS OF 6-DEHYDRO-16-METHYLENE-HYDROCORTISONE (STC 407) AND DEXAMETHASONE ON THE SUPPRESSION OF THE HYPOTHALAMO-PITUITARY-ADRENAL SYSTEM

1970 ◽  
Vol 63 (3) ◽  
pp. 423-430 ◽  
Author(s):  
K. Berthold ◽  
A. Arimura ◽  
A. V. Schally
Keyword(s):  
Cushing’S Syndrome ◽  
Successful Treatment ◽  
Cushing's Syndrome ◽  
Regulatory Function ◽  
Adrenal Hyperplasia ◽  
Adrenal System ◽  
Pituitary Glands ◽  
Adrenal Corticosterone

ABSTRACT The suppressive effects of 6-dehydro-16-methylene-hydrocortisone (STC 407) and dexamethasone on the hypothalamo-pituitary-adrenal system were evaluated in the rat. Four μg dexamethasone or 120 μg STC 407/100 g b. w. was injected ip daily into normal rats for 16 or 31 days. These doses were of approximately equivalent antiinflammatory potencies. Both steroids decreased equally plasma and adrenal corticosterone concentrations as well as adrenal weights. However, CRF activities of the hypothalamus and ACTH contents of the pituitary glands were significantly reduced by treatment with STC 407, but not with dexamethasone. This finding may endorse the successful treatment with STC 407 of Cushing's syndrome due to adrenal hyperplasia in which the fundamental derangement appears to consist of a disturbed regulatory function of the hypothalamus.

DIAGNOSIS OF CUSHING'S SYNDROME

1969 ◽  
Vol 60 (1) ◽  
pp. 47-59 ◽  
Author(s):  
H. Bethge ◽  
M. Bayer ◽  
W. Winkelmann
Keyword(s):  
Cushing’S Syndrome ◽  
Opposite Effect ◽  
Adrenal Adenoma ◽  
Cushing's Syndrome ◽  
Adrenal Hyperplasia ◽  
Adrenal System ◽  
Lysine Vasopressin ◽  
Normal Increase ◽  
High Degree

ABSTRACT Adrenal function tests were performed in 9 patients with Cushing's syndrome (6 with adrenal hyperplasia and 3 with adrenal adenoma) in order to study the hypothalamus-pituitary-adrenal system. These tests involved the determination of a) diurnal rhythm of plasma corticosteroids (11-OHCS) and the effect of corticotrophin (ACTH) and dexamethasone administration, b) urinary corticosteroid excretion (17-OHCS), basal and after ACTH, dexamethasone and metapyrapone treatment and c) cortisol production rate. In addition the patients were submitted to insulin-induced hypoglycaemia and intravenous infusion of synthetic lysine-vasopressin and the plasma corticosteroids were determined. All 9 patients regardless of the nature of adrenal pathology responded to insulin-induced hypoglycaemia in the same manner and failed to show the normal increase of 11-OHCS. During lysine-vasopressin infusion an opposite effect was observed: all 6 patients with hyperplasia showed a distinct rise in plasma corticosteroids in contrast to the 3 patients with adenoma who did not respond at all. These findings show that the lysine-vasopressin test may be very useful in differentiating between adrenal hyperplasia and adrenal adenoma. This procedure is recommended as a screening test because of its simplicity and high degree of diagnostic accuracy. Results are discussed with regard to the different pathogenesis of the two forms of Cushing's syndrome.

CUSHING'S SYNDROME FOLLOWING PARTIAL ADRENALECTOMY AND COMPLETE HYPOPHYSECTOMY

1965 ◽  
Vol 48 (4) ◽  
pp. 565-568 ◽  
Author(s):  
W. A. Sullivan ◽  
Jerrold D. Hydovitz ◽  
H. Rosomoff ◽  
T. S. Danowski
Keyword(s):  
Cushing’S Syndrome ◽  
Adult Male ◽  
Successful Treatment ◽  
Cushing's Syndrome ◽  
Partial Adrenalectomy ◽  
The Third ◽  
Subtotal Adrenalectomy ◽  
Pituitary Ablation ◽  
Acth Secreting

ABSTRACT A third episode of Cushing's syndrome developed in an adult male who had undergone subtotal adrenalectomy and then complete hypophysectomy in temporarily successful treatment of two earlier episodes. Judging from necropsy findings, this final recurrence was not the result of incomplete pituitary ablation or regeneration of pituitary remnants. Extrasellar pituitary or other ACTH secreting tissue could not be identified, but the patient's marked melanosis suggested its presence with consequent excesses of ACTH or MSH. However, irrespective of whether such excesses did or did not exist, it is clear that the third episode of Cushing's syndrome resulted from hyperfunction of the small adrenal remnant.

QUANTITATIVE ESTIMATION OF URINARY PREGNANETRIOL, PREGNANETRIOLONE, TETRAHYDRO S AND Δ5-PREGNENETRIOL IN THE INVESTIGATION OF ADRENOCORTICAL FUNCTION

1969 ◽  
Vol 60 (4) ◽  
pp. 657-668 ◽  
Author(s):  
Frances J. Thomas ◽  
A. W. Steinbeck
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Cushing’S Syndrome ◽  
Adrenocortical Carcinoma ◽  
Quantitative Estimation ◽  
Cushing's Syndrome ◽  
Adrenocortical Function ◽  
Adrenal Hyperplasia ◽  
Ectopic Acth ◽  
Modified Method ◽  
Idiopathic Hirsutism

ABSTRACT A modified method for the estimation of urinary pregnanetriol, pregnanetriol, pregnanetriolone, Δ5-pregnenetriol and tetrahydro S was investigated. The steroids, separated by chromatography, were measured quantitatively, tetrahydro S by reaction with blue tetrazolium and the other three as acetaldehydogenic substances. The excretion of these steroids was studied in suspected instances of adrenal and/or ovarian disease. Urinary pregnanetriol and tetrahydro S levels were normal in Cushing's syndrome, secondary adrenocortical carcinoma, the Stein-Leventhal syndrome, idiopathic hirsutism and hypertension. Tetrahydro S was doubtfully elevated in an instance of ectopic ACTH Cushing's syndrome. Pregnanetriol excretion was elevated in untreated cases of congenital adrenal hyperplasia and after treatment in some. Pregnanetriolone was found in all patients with congenital adrenal hyperplasia, including those receiving cortisone. Pregnanetriolone was also detected in Cushing's syndrome, secondary adrenocortical carcinoma, the Stein-Leventhal syndrome, ectopic ACTH Cushing's syndrome and suspected congenital adrenal hyperplasia. Δ5-pregnenetriol was present as a glucuronide in the Stein-Leventhal syndrome and idiopathic hirsutism. The diagnostic implications of these results are discussed.

Sudoreses as First Manifestation of Cushing's Syndrome ACTH-Independent Macronodular Adrenal Hyperplasia.

2010 ◽  
pp. P3-679-P3-679
Author(s):  
MP Ferraz ◽  
MS Neres ◽  
DR de Moraes ◽  
APC Normando ◽  
LA Pelluci
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenal Hyperplasia

scholarly journals Long-term low-dose ketoconazole treatment in bilateral macronodular adrenal hyperplasia

2014 ◽  
Vol 2014 ◽  
Author(s):  
Sophie Comte-Perret ◽  
Anne Zanchi ◽  
Fulgencio Gomez
Keyword(s):  
Medical Therapy ◽  
Cushing’S Syndrome ◽  
Clinical Signs ◽  
Cushing's Syndrome ◽  
List Type ◽  
Adrenal Hyperplasia ◽  
Benign Condition ◽  
Steroid Secretion ◽  
Free Cortisol

Summary Medical therapy for Cushing's syndrome due to bilateral macronodular adrenal hyperplasia (BMAH) is generally administered for a limited time before surgery. Aberrant receptors antagonists show inconsistent efficacy in the long run to prevent adrenalectomy. We present a patient with BMAH, treated for 10 years with low doses of ketoconazole to control cortisol secretion. A 48-year-old woman presented with headaches and hypertension. Investigations showed the following: no clinical signs of Cushing's syndrome; enlarged lobulated adrenals; normal creatinine, potassium, and aldosterone; normal urinary aldosterone and metanephrines; elevated urinary free cortisol and steroid metabolites; and suppressed plasma renin activity and ACTH. A screening protocol for aberrant adrenal receptors failed to show any illegitimate hormone dependence. Ketoconazole caused rapid normalisation of cortisol and ACTH that persists over 10 years on treatment, while adrenals show no change in shape or size. Ketoconazole decreases cortisol in patients with Cushing's syndrome, and may prevent adrenal overgrowth. Steroid secretion in BMAH is inefficient as compared with normal adrenals or secreting tumours and can be controlled with low, well-tolerated doses of ketoconazole, as an alternative to surgery. Learning points Enlarged, macronodular adrenals are often incidentally found during the investigation of hypertension in patients harboring BMAH. Although laboratory findings include low ACTH and elevated cortisol, the majority of patients do not display cushingoid features. Bilateral adrenalectomy, followed by life-long steroid replacement, is the usual treatment of this benign condition, and alternative medical therapy is sought. Therapy based on aberrant adrenal receptors gives disappointing results, and inhibitors of steroidogenesis are not always well tolerated. However, ketoconazole at low, well-tolerated doses appeared appropriate to control adrenal steroid secretion indefinitely, while preventing adrenal overgrowth. This treatment probably constitutes the most convenient long-term alternative to surgery.

scholarly journals A Case of Congenital Adrenal Hyperplasia Mimicking Cushing's Syndrome

2012 ◽  
Vol 27 (11) ◽  
pp. 1439 ◽  
Author(s):  
Hye Jeong Kim ◽  
Mira Kang ◽  
Jae Hyeon Kim ◽  
Sun Wook Kim ◽  
Jae Hoon Chung ◽  
...  
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Adrenal Hyperplasia
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