In vitro secretion of pro-opiomelanocortin (POMC) derived peptides in human ACTH-producing pituitary adenomas: evaluation of hormone ratios in different functional states

Profound amplification of secretory-burst mass and anomalous regularity of ACTH secretory process in patients with Nelson's syndrome compared with Cushing's disease

OBJECTIVE

As described originally, Nelson's syndrome is characterized by grossly elevated ACTH concentrations, a sellar mass and skin hyperpigmentation emerging in the course of Cushing's disease after bilateral adrenalectomy. No detailed studies have defined whether the mechanisms directing ACTH secretion differ in Nelson's syndrome and untreated Cushing's disease.

PATIENTS AND METHODS

To address this pathophysiological issue, we studied nine patients fulfilling the criteria of Nelson's syndrome receiving glucocorticoid and mineralocorticoid replacement; nine patients with untreated pituitary-dependent Cushing's disease and nine gender- and age-matched controls. ACTH release was appraised by monitoring plasma ACTH concentrations in blood samples collected every 10 min for 24 h. ACTH secretion rates and endogenous decay were quantified by multiparameter deconvolution analysis. The orderliness of the ACTH release process was delineated by the approximate entropy (ApEn) statistic. Diurnal variation in ACTH secretion was appraised by cosinor analysis.

RESULTS

Basal ACTH secretion was increased sixfold and pulsatile secretion ninefold in patients with Nelson's syndrome compared with Cushing's disease (P </= 0.01 and P </= 0.001, respectively). The increase in pulsatile secretion was due to an eightfold augmentation of burst mass. Event frequency was comparable in both patient groups (32 +/- 1 vs. 28 +/- 2 pulses/24 h), and higher than in normal controls (22 +/- 1 pulses/24 h, P < 0.0001). Paradoxically, the consistency of subordinate patterns of serial ACTH release, albeit disrupted in active Cushing's disease, was normal in Nelson's syndrome (P = 0.014). Normal ACTH secretory-process regularity in Nelson's syndrome was attributable to a more reproducible (lower ApEn) succession of ACTH secretory-burst mass denoting more uniform amplitude evolution over 24 h (P = 0.007, Nelson vs. Cushing). However, the quantifiable regularity of serial interburst intervals (waiting times) was unexpectedly elevated in Nelson's syndrome (P = 0.022). Nelson patients maintained a significant diurnal rhythm in ACTH release, which was marked by a 15-fold greater amplitude (P = 0.0018 vs. Cushing's) and a 4-h acrophase (maximum) delay (P = 0.037 vs. control).

CONCLUSION

The present detailed analyses delineate marked ACTH secretory-burst mass amplification and (amplitude-independent) anomalous regularity of successive pulse size and timing in Nelson's syndrome compared with Cushing's disease or controls. We postulate that the foregoing novel distinctions are due to unique tumoural secretory properties, concurrently required glucocorticoid replacement and/or hypothalamic injury associated with prior radiotherapy in Nelson's syndrome.

Metabolic profiling of radioreceptor-assayable opioid peptides in a human pituitary ACTH-secreting tumor

The profile of endogenous opioid peptides in the peptide-rich fraction obtained from a homogenate of an ACTH-secreting human pituitary tumor is presented. Gradient RP-HPLC is used to separate the mixture into peptide constituents. A preparation of opioid receptors is used in a radioreceptor assay with ethorphine - a relatively non-specific ligand that is used as a screen because it interacts with mu, sigma, and delta receptors - as the HPLC detector to detect a range of peptides that derive from proenkephalin A and POMC.

Characterization of immunoreactive beta-endorphin secreted from cultured human corticotropin-secreting adenomas

Seven human corticotropin-secreting adenomas causing Cushing's disease or Nelson's syndrome were maintained in long-term culture. Pooled media from the individual adenomas were analyzed for the composition of their secretory products. From a radioimmunoassay (RIA) with 100% cross-reactivity for human beta-endorphin (beta h-EP) and beta-lipotropin (beta h-LPH), immunoreactive beta h-EP (IR X beta h-EP) was found to be the predominant secretory product after Sephadex G-50 analysis in 4 cases (40-80% of total IR), immunoreactive beta h-LPH (IR X beta h-LPH) predominated in 1 case, and both were equipresent in 2-cases. IR X beta h-EP was further purified by high-performance liquid chromatography (HPLC) and analyzed in 4 cases with ion-exchange chromatography on SP-Sephadex C-25 and a RIA which completely cross-reacts with beta h-EP, [N alpha-Ac]-beta h-EP, beta h-EP-(1-27) and [N alpha-Ac]-beta h-EP-(1-27). In all cases, the IR X beta h-EP was the main component (40-70%); the remaining IR material was attributable partially to [N alpha-Ac]-beta h-EP or other, less defined immunoreactive material. In 3 cases, enough IR X beta h-EP material was available for HPLC and to perform a radioreceptor assay using tritiated beta h-EP as primary ligand. The displacing potency of these preparations relative to synthetic beta h-EP was related to the content of the immunoreactive component eluting in the position of synthetic beta h-EP.