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Paradoxical surge of corticotropin after glucocorticoid replacement in central adrenal insufficiency.

Yamashita K, Doden T, Tanaka M, Funase Y, Yamauchi K, Furukawa T, Oguchi K, Koyama T, Aizawa T.
Case Reports 2012; 33(2): 113-117 PubMed PMID: 22592190 Citation  Keywords:  Adrenal Insufficiency:blood, Adrenocorticotropic Hormone:blood, Aged, Glucocorticoids:pharmacology, Humans, Hydrocortisone:pharmacology, Male, Pituitary Gland, Anterior:drug effects,.   

: A 78-yr-old man was admitted in emergency with fatigue, anorexia, vomiting, hypothermia (35.1 °C on a hot August day), hypotension (89/56 mmHg) and hyponatraemia (126 mEq/l). Plasma corticotropin and cortisol were severely depressed: 0.84 pmol/L and 33.1 nmol/L respectively (reference range, 1.5-13.9 pmol/L and 110-505 nmol/L, respectively). Thyroid stimulating hormone was low-normal and free-triiodothyronine and free-thyroxine were subnormal. Magnetic resonance imaging revealed swelling of the pituitary gland and the stalk. The patient recovered after glucocorticoid replacement (200 mg/day intravenous hydrocortisone on Day 1 followed by tapering). Central diabetes insipidus which had become apparent had been treated with 1-desamino-8-D-arginine vasopressin. A surge of corticotropin and cortisol, 19.4 pmol/L and 712.1 nmol/L respectively, was found on Day 5 when luteinizing hormone, follicle stimulating hormone, and testosterone were subnormal and prolactin was slightly elevated. Subsequently, corticotropin and cortisol levels normalized together with normalization of luteinizing hormone, follicle stimulating hormone, anti-diuretic hormone, thyroid stimulating hormone, prolactin, testosterone and thyroid hormone levels. Shrinkage of the pituitary gland occurred after one month. Serum immunoglobulin G4 was elevated (3.21 and 6.02 g/l at 1- and 3-month follow-ups respectively). In conclusion, a paradoxical surge of corticotropin after glucocorticoid replacement was observed in a patient with central adrenal insufficiency due to immunoglobulin G4-related hypophysitis. Surge of ACTH in central adrenal insufficiency after glucocorticoid replacement has rarely been reported, and this is the second such case report....

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Steroid modulation of angiotensin II action in the rat anterior pituitary gland.

Lachowicz A, Ochedalski T, Rebas E.
Journal Article 2003; 24(1-2): 91-95 PubMed PMID: 12743541 Citation  Keywords:  Angiotensin II:pharmacology, Animals, Dehydroepiandrosterone Sulfate:pharmacology, Estradiol:pharmacology, Female, Injections, Intraperitoneal, Inositol 1,4,5-Trisphosphate:metabolism, Male, Pituitary Gland, Anterior:drug effects, Pregnenolone:pharmacolog.   

OBJECTIVES: The present study was designed to test whether various steroid hormones modulate differently angiotensin II (AngII) action in the anterior pituitary in males and females.

MATERIAL AND METHODS: Adult female and male rats were treated with one of the following substances: oil (control), pregnenolone sulfate (PREG-S), 17beta-estradiol benzoate (E2,) progesterone (P), or dehydroepiandrosterone sulfate (DHEA-S), given in intraperitoneal injections for five days in dose of 50 microg per animal per day. Because AngII is known to act in the anterior pituitary through the phosphatidiloinositol breakdown, thus increasing the level of inositol-1,4,5-trisphosphate (IP3), the IP3 concentration was determined 24 hours after the injection in the anterior pituitary homogenate exposed to AngII.

RESULTS: In control animals (without steroids) AngII stimulated concentration of IP(3) stronger in females than in males. E(2) and DHEA-S enhanced AngII effects in both males and females. PREG-S increased AngII-induced IP(3) concentration in females, but not males. Progesterone raised AngII effect on IP(3) concentration in males, only when high concentrations of peptide were used.

CONCLUSION: These results indicate that pituitary sensitivity to AngII stimulation is modulated by steroid hormones and is related to the gender of the animal....

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Dehydroepiandrosterone regulation of prolactin gene expression in the anterior pituitary does not depend on galanin induction.

Piroli G, Pietranera L, Grillo C, De Nicola A.
Journal Article 2002; 23(4): 321-324 PubMed PMID: 12195234 Citation  Keywords:  Adjuvants, Immunologic:pharmacology, Animals, Carcinogenicity Tests, Dehydroepiandrosterone:pharmacology, Estradiol:pharmacology, Female, Galanin:genetics, Gene Expression:drug effects, Pituitary Gland, Anterior:drug effects, Prolactin:blood, RNA, Messeng.   

OBJECTIVES: The effects of dehydroepiandrosterone (DHEA) on galanin (GAL) and prolactin (PRL) mRNA expression in the anterior pituitary of Fischer 344 rats were studied, taking in consideration that: (1) DHEA is an androgen with estrogenic activity on pituitary lactotrophs; (2) estrogens induce prolactinomas in Fischer 344 rats; and (3) GAL has been considered the main mediator of estrogen-induced lactotroph proliferation.

DESIGN: Female rats were ovariectomized and used as controls or treated during 2 weeks with DHEA (500 mg/kg/day or 5 mg/kg/day or 50 mg/kg/day) or estradiol (E2, 50 microg/kg/day), as a positive control for pituitary growth and GAL induction. GAL and PRL mRNA expression were studied by in situ hybridization.

RESULTS: Both DHEA and E2 induced PRL mRNA synthesis. However, DHEA neither produced pituitary enlargement nor GAL induction, in contrast to E2.

CONCLUSIONS: Our results shows that GAL is not involved in the estrogenic activity of DHEA on pituitary lactotrophs, and suggest that DHEA effects are exerted directly on the PRL gene or through another mechanism(s) not related to GAL....

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