New hypothalamic hormone, corticotropin-releasing factor, specifically stimulates the release of adrenocorticotropic hormone and cortisol in man

The hypothalamus and its role in hypertension

For the majority of hypertensive patients, the etiology of their disease is unknown. The hypothalamus is a central structure of the brain which provides an adaptive, integrative, autonomic, and neuroendocrine response to any fluctuations in physiological conditions of the external or internal environment. Hypothalamic insufficiency leads to severe metabolic and functional disorders, including persistent increase in blood pressure. Here, we discuss alterations in the neurochemical organization of the paraventricular and suprachiasmatic nucleus in the hypothalamus of patients who suffered from essential hypertension and died suddenly due to acute coronary failure. The changes observed are hypothesized to contribute to the pathogenesis of disease.

Fast Feedback Inhibition of Adrenocorticotropic Hormone Secretion by Endogenous Cortisol in Humans

BACKGROUND

Using high-frequency blood sampling, we demonstrate glucocorticoid fast feedback (FF) mediated by endogenous cortisol in 6 normal humans.

METHODS

We stimulated adrenocorticotropic hormone (ACTH) secretion by ovine corticotropin-releasing hormone (oCRH) with the experimental paradigm in which a high-frequency blood sampling was designed for plasma ACTH and cortisol determinations.

RESULTS

We saw previously unrecognized variability in the timing of key events such as onsets of ACTH and cortisol secretion, onset and offset of FF, and in FF duration. This variability mandated analyses referenced to case-wise event times rather than referenced simply to time since oCRH administration. The mean time of FF onset was 4.0 min (range 0-9; median 3) after cortisol secretion began, and the mean FF duration was 7.5 min (range 3-18; median 6.0). The FF effect was rate-sensitive and does not reflect level-sensitive cortisol feedback. In agreement with previous estimates using hydrocortisone infusions, the rate of rise of cortisol that triggered FF was approximately 44 nmol/L/min or 1.6 µg/dL/min. FF onset followed the trigger cortisol slope with an average lag of 1 min (range 0-3; median 0). Unexpectedly, this trigger cortisol slope quickly declined within the FF period.

CONCLUSIONS

This experimental design may enable new physiological studies of human FF that is mediated by endogenous cortisol, including mechanisms, reproducibility, and generalizability to other activating stimuli.

The neurochemistry and social flow of singing: bonding and oxytocin

Music is used in healthcare to promote physical and psychological well-being. As clinical applications of music continue to expand, there is a growing need to understand the biological mechanisms by which music influences health. Here we explore the neurochemistry and social flow of group singing. Four participants from a vocal jazz ensemble were conveniently sampled to sing together in two separate performances: pre-composed and improvised. Concentrations of plasma oxytocin and adrenocorticotropic hormone (ACTH) were measured before and after each singing condition to assess levels of social affiliation, engagement and arousal. A validated assessment of flow state was administered after each singing condition to assess participants' absorption in the task. The feasibility of the research methods were assessed and initial neurochemical data was generated on group singing. Mean scores of the flow state scale indicated that participants experienced flow in both the pre-composed (M = 37.06) and improvised singing conditions (M = 34.25), with no significant difference between conditions. ACTH concentrations decreased in both conditions, significantly so in the pre-composed singing condition, which may have contributed to the social flow experience. Mean plasma oxytocin levels increased only in response to improvised singing, with no significant difference between improvised and pre-composed singing conditions observed. The results indicate that group singing reduces stress and arousal, as measured by ACTH, and induces social flow in participants. The effects of pre-composed and improvised group singing on oxytocin are less clear. Higher levels of plasma oxytocin in the improvised condition may perhaps be attributed to the social effects of improvising musically with others. Further research with a larger sample size is warranted.

How a calculated oxidative stress can yield multiple therapeutic effects

It is proposed to discuss how ozonetherapy acts on patients affected by vascular and degenerative diseases. Ozone is a strong oxidant but, if used in small dosages on human blood ex vivo, acts as an acceptable stressor. By instantly reacting with PUFA bound to albumin, ozone is entirely consumed but generates two messengers acting in an early and in a late phase: the former is due to hydrogen peroxide, which triggers biochemical pathways on blood cells and the latter is due to alkenals which are infused into the donor patient. After undergoing a partial catabolism, alkenals enter into a great number of body's cells, where they react with Nrf2-Keap1 protein: the transfer of activated Nrf2 into the nucleus and its binding to antioxidant response element (ARE) is the crucial event able to upregulate the synthesis of antioxidant proteins, phase II enzymes and HO-1. With the progress of ozonetherapy, these protective enzymes are able to reverse the oxidative stress induced by chronic inflammation. Consequently, the repetition of graduated stresses induces a multiform adaptive response able to block the progress of the disease and to improve the quality of life.

Inferior petrosal sinus ACTH and prolactin responses to CRH in ACTH-dependent Cushing's syndrome: a single centre experience from the United Kingdom

Inferior petrosal sinus sampling (IPSS) of ACTH with CRH stimulation helps distinguish pituitary ACTH-dependent Cushing's syndrome from the ectopic ACTH syndrome (EAS). The usefulness of the paradoxical response of other pituitary hormones including prolactin to CRH remains controversial. Data from 33 IPSS procedures carried out at the Walton Centre for Neurology and Neurosurgery in Liverpool were analyzed. Patients were selected for this procedure if they had been diagnosed with ACTH dependent Cushing's syndrome and the majority had no obvious pituitary adenoma on Magnetic Resonance Imaging. Satisfactory simultaneous bilateral catheterization was accomplished in 23/33 (success rate 70%). The diagnostic sensitivity of a basal central/peripheral ACTH ratio >2.0 and >3 post-CRH was 94%. In two patients with subsequently confirmed EAS the maximal central/peripheral ACTH ratio was <2.0 on basal samples and did not change following CRH. The maximal central/peripheral prolactin ratio was noted at 5 min post-CRH, coinciding with the maximal central/peripheral ACTH ratio. The intersinus gradient (ISG) of ACTH was paralleled by a consistent ISG of prolactin and in 7 out of 9 patients (with successful bilateral IPSS and unilateral adenomas) the ISG of prolactin correctly lateralized the microadenoma whereas the ISG of ACTH correctly lateralized in 8 out of 9 patients. Neither of the patients with EAS achieved a central/peripheral prolactin ratio >2 in the basal state and >3 post-CRH. Bilateral catheterization of inferior petrosal sinuses can be successful in up to 70% of cases. Prolactin measurements do not have superior lateralizing capability compared with ACTH but may be useful in the differential diagnosis of pituitary-driven from EAS.

Effects of synthetic corticotropin-releasing factor in normal individuals and in patients with hypothalamic-pituitary-adrenocortical disorders

Plasma adrenocortical hormone (ACTH) and cortisol response to four dose levels (25, 50, 100 and 300 micrograms) corticotropin-releasing factor (CRF) were studied in 5 healthy men, and the response to 100 micrograms CRF in 12 patients with various disorders of the hypothalamic-pituitary-adrenocortical function. In normals, mean plasma ACTH and cortisol concentration rose at all dose levels of CRF and peaked at 30 and 60 min respectively. The increment in plasma cortisol at 60 and 90 min was significantly higher on 100 and 300 micrograms CRF than on 25 micrograms, but the total cortisol concentration was not. Seven patients had Cushing's syndrome. In 2 patients with adrenocortical carcinoma the basal plasma ACTH was suppressed. After CRF a small increase was seen in plasma ACTH and cortisol in one patient successfully treated with mitotane, while the other patient did not respond. In 1 patient with ectopic ACTH syndrome an increase in plasma ACTH 15 min after CRF was not accompanied by any increase in plasma cortisol. One patient with bilateral multinodular adrenocortical hyperplasia did not respond to CRF. The plasma ACTH and cortisol response to CRF was supernormal in 2 patients with Cushing's disease, while a third patient responded in the normal range. In 2 patients with Nelson's syndrome the plasma ACTH response was excessive. Two out of three hypophysectomized patients did not respond to CRF, while one patient with a slightly positive response to hypoglycemia also responded (subnormally) to CRF. Our data indicate that CRF in doses of 50-100 micrograms will be a valuable substance in the differential diagnosis of Cushing's syndrome. Some overlap in the response is, however, seen between patients with Cushing's disease and other patients with Cushing' syndrome. CRF will possibly be of value also for the diagnosis of secondary adrenocortical failure.

The role of corticotropin-releasing factor in the investigation of endocrine diseases

Since the discovery and structural elucidation of corticotropin-releasing factor (CRF) synthetic ovine and human CRF have become useful tools for the diagnosis of pituitary and adrenocortical disorders. The stimulation of release of adrenocorticotropic hormone (ACTH) after a dose of 100 micrograms CRF allows differentiation of the various causes of secondary adrenal insufficiency. In patients with specific autoimmune corticotroph disorders or general inflammatory or tumorous destruction of the anterior pituitary there is no rise of ACTH after intravenous administration of CRF. In contrast, patients with secondary adrenal failure due to suprasellar lesions show a rise of ACTH from a low or unmeasurable basal level without an accompanying cortisol response, demonstrating the integrity of the corticotroph and the atrophy of the cRF neuron and the adrenocortical cell. Similar observations are made in patients with secondary adrenal failure resulting from long-term glucocorticoid treatment. This demonstrates that the main reason for adrenal insufficiency after glucocorticoid treatment is the persisting suppression of the activity of CRF neurons. In patients with adrenocortical hyperfunction (Cushing's syndrome) the CRF stimulation test differentiates unequivocally between autonomous adrenal hypercortisolism and ACTH-dependent bilateral adrenal hyperplasia. However, the differential diagnosis between eutopic pituitary (Cushing's disease) and paraneoplastic ACTH secretion (ectopic ACTH syndrome) is difficult. Recent results show that catheterization of the sinus petrous inferior and measurement of ACTH in central and peripheral blood before and after CRF injection allows this differential diagnosis to be made with confidence. The usefulness of measuring CRF plasma levels is not established. The only exception to this is in cases of ectopic CRF syndrome, which is a rare cause of Cushing's syndrome.

Paraventricular nucleus of the human hypothalamus in primary hypertension: activation of corticotropin-releasing hormone neurons

By using quantitative immunohistochemical and in situ hybridization techniques, we studied corticotropin-releasing hormone (CRH) -producing neurons of the hypothalamic paraventricular nucleus (PVN) in patients who suffered from primary hypertension and died due to acute cardiac failure. The control group consisted of individuals who had normal blood pressure and died of acute heart failure due to mechanical trauma. Both magno- and parvocellular populations of CRH neurons appeared to be more numerous in the PVN of hypertensive patients. Quantitative analysis showed approximately a twofold increase in the total number of CRH neurons and a more than fivefold increase in the amount of CRH mRNA in the hypertensive PVN compared with the control. It is suggested that synthesis of CRH in hypertensive PVN is enhanced. Increased activity of CRH-producing neurons in the PVN of hypertensive patients is proposed not only to entail hyperactivity of the hypothalamo-pituitary-adrenal axis, but also of the sympathetic nervous system and, thus, to be involved in the pathogenesis of hypertension.

The corticotropin-releasing hormone test in the diagnosis of ACTH-dependent Cushing's syndrome: a reappraisal

OBJECTIVE

Stimulation with corticotropin-releasing hormone (CRH) is one of principal tools for the differential diagnosis of ACTH-dependent Cushing's syndrome. However, different dosages and species of CRH may be employed; further, ACTH levels can be measured by radioimmunoassay (RIA) or immunoradiometric assay (IRMA). The aims of the present study were to perform a reappraisal of the diagnostic accuracy of the CRH test taking these different testing modalities into consideration and to study the correlation between basal ACTH and cortisol levels and their responses to CRH in patients with Cushing's disease.

PATIENTS

The study population comprised 148 patients with Cushing's disease and 12 patients with ectopic ACTH secretion collected through an Italian multicentre study.

DESIGN

Patients were submitted to stimulation with 100 microg human or ovine CRH (36% and 64% of subjects, respectively) and ACTH measured either by RIA or IRMA (28% and 72%, respectively). A 50% increase in ACTH and cortisol levels was considered indicative of Cushing's disease.

RESULTS

Mean peak ACTH levels measured by RIA and IRMA were comparable, as was the diagnostic accuracy of the test with the two assays (87% for IRMA and 84% for RIA, ns). In patients with Cushing's disease, stimulation with ovine CRH induced greater hormonal responses compared to testing with human CRH although only the cortisol response reached statistical significance (ACTH: 247.5 +/- 28.0% vs. 168.5 +/- 21.3% over baseline, P = 0.06; cortisol: 89.3 +/- 8.5% vs. 60.8 +/- 9.6% over baseline, P < 0.05 for ovine and human CRH, respectively). No appreciable rise in ACTH and cortisol levels was registered among patients with ectopic ACTH secretion. Diagnostic accuracy of the cortisol response was significantly greater with the ovine than with human peptide (71% vs. 49%, P < 0.05, for ovine and human CRH, respectively) while the ACTH response yielded equal diagnostic accuracy (86% vs. 87%, ns, for the ovine and human peptide, respectively). Interestingly, the correlation between ACTH and cortisol peak responses in patients with Cushing's disease was significantly greater for human than for ovine CRH (r = 0.68 vs. r = 0.41, P < 0.01, respectively). In addition, baseline cortisol levels exhibited a significant negative correlation with both the ACTH and cortisol response to CRH suggesting the persistence of the negative cortisol feedback in patients with Cushing's disease.

CONCLUSIONS

(A) Both RIA and IRMA can be used indifferently for the assessment of the ACTH response to CRH. (B) Human and ovine CRH provide the same diagnostic accuracy as regards the ACTH response which, incidentally, represents the most accurate criterion for the evaluation of the CRH test; ovine CRH is superior to the human peptide in the evaluation of the cortisol response. (C) In patients with Cushing's disease, endogenous cortisol maintains the ability to negatively modulate CRH-stimulated corticotropin secretion.

Corticotropin-releasing hormone receptor (type I) antisense targeting reduces anxiety

Two brain-derived corticotropin-releasing hormone receptors have been cloned, termed corticotropin-releasing hormone receptors type I and type 2. Antisense oligodeoxynucleotides targeted to the cloned rat and mouse corticotropin-releasing hormone receptors type I messenger RNA reduced the binding of the natural ligand of the corticotropin-releasing hormone receptors type I and also the release of adenocorticotrophic hormone in primary rat anterior pituitary cells and in clonal mouse pituitary cells (AtT-20) by up to 60% in an application time-dependent manner. Studies on intracellular uptake of fluorescence-labelled oligodeoxynucleotides indicated a cytoplasmic accumulation starting within two to four hours after application of oligodeoxynucleotides in vitro. In vivo, antisense oligodeoxynucleotides infused intra-cerebroventricularly reduced binding of radiolabelled corticotropin-releasing hormone receptors in central sites of the rat brain. Anxiety induced by i.c.v. administration of corticotropin-releasing hormone was attenuated by corticotropin-releasing hormone receptors type I antisense treatment as determined in the elevated plus maze and in the novel open field test. The corticotropin-releasing hormone-induced behavioural changes were absent in corticotropin-releasing hormone receptors type I antisense-pretreated animals. These results show that the selected antisense probes used were able to suppress corticotropin-releasing hormone receptors type I function in vitro as well as in vivo and suggest that the development of drugs blocking this specific receptor might lead to a novel class of anxiolytics.

Direct effects of corticotrophin-releasing hormone on stimulated growth hormone secretion

OBJECTIVE

This study evaluated the effect of corticotrophin-releasing hormone (CRH) on growth hormone releasing hormone (GHRH)-stimulated growth hormone (GH) release in man.

DESIGN

Six healthy adult volunteers (age 20-35 years) were studied. On different occasions they each received an intravenous bolus of saline, CRH(1-41) (100 micrograms), adrenocorticotrophic hormone (ACTH) [Synacthen (500 ng/m2)] or hydrocortisone (50 mg), followed 30 minutes later by an intravenous bolus of either GHRH-(1-29)-NH2 (1.0 microgram/kg) or saline.

MEASUREMENT

Serum GH concentrations were measured using an immunoradiometric assay, and cortisol concentrations were measured by commercial radioimmunoassay. TSH concentrations were measured using a solid phase immunoradiometric assay kit.

RESULTS

Pretreatment with CRH(1-41) attenuated the GH response to GHRH [saline/GHRH-(1-29)-NH2 20.2 +/- 6.2 mU/l; CRH(1-41)/GHRH-(1-29)-NH2 10.9 +/- 2.8 mU/l (P = 0.01)]. This effect was not due to the rise in ACTH or cortisol induced by CRH(1-41), since pretreatment with either ACTH or hydrocortisone significantly augmented the GH response to GHRH-(1-29)-NH2 in the same subjects [ACTH/GHRH-(1-29)-NH2 30.3 +/- 8.8 mU/l (P = 0.01); hydrocortisone/GHRH-(1-29)-NH2 36.4 +/- 11.2 mU/l (P = 0.02)].

CONCLUSION

Our data suggest that the inhibitory effect of CRH(1-41) on GHRH-(1-29)-NH2-induced GH release is not a result of ACTH or cortisol release but reflects a direct action of CRH on GH secretion, possibly via stimulation of somatostatin release. The acute rise in GH following glucocorticoid administration could be explained in part by a rapid suppression of endogenous CRH.

The Ovine Corticotropin-Releasing Hormone Stimulation Test in the Differential Diagnosis of Adrenocorticotropic Hormone-Dependent Cushing’s Syndrome

OBJECTIVE

To determine the efficacy of the ovine corticotropin-releasing hormone (oCRH) stimulation test in distinguishing between adrenocorticotropic hormone (ACTH)-dependent types of Cushing's syndrome.

METHODS

The cortisol and ACTH responses to intravenously administered oCRH were determined in 64 patients with pituitary-dependent Cushing's syndrome and 13 patients with ectopic ACTH production.

RESULTS

Of the 64 patients with pituitary-dependent Cushing's syndrome, 57 (89%) had a positive ACTH response to administration of oCRH (an increase of 50% or more above baseline), and 56 (88%) had a positive cortisol response (an increase of 20% or more above baseline). One patient with an ectopic ACTH-secreting tumor had a false-positive cortisol response to administration of oCRH. Two patients with ectopic ACTH-secreting tumors had false-positive responses to both ACTH and cortisol after oCRH was administered. Because both these patients did not have hypercortisolemia at the time of testing, they were excluded from the statistical analysis. When analyzed on the basis of ACTH response alone, oCRH testing yielded a diagnostic sensitivity and specificity for the diagnosis of pituitary-dependent hypercortisolism of 89% and 100%, respectively. The positive predictive value was 100%, and the negative predictive value was 61%.

CONCLUSION

oCRH testing distinguished between the ectopic ACTH syndrome and pituitary-dependent hyper-cortisolism in most cases. Therefore, this test is a useful procedure in the diagnostic evaluation of ACTH-dependent forms of Cushing's syndrome.

Physiological and endocrine effects of social contact

Nonnoxious sensory stimulation associated with friendly social interaction induces a psychophysiological response pattern involving sedation, relaxation, decreased sympathoadrenal activity, and increased vagal nerve tone and thereby an endocrine and metabolic pattern favoring the storage of nutrients and growth. It is suggested that oxytocin released from parvocellular neurons in the paraventricular nucleus (PVN) in response to nonnoxious stimulation integrates this response pattern at the hypothalamic level. The response pattern just described characterized by calm, relaxation, and anabolic metabolism could be regarded as an antithesis to the well known fight-flight response in which mental activation, locomotor activity, and catabolic metabolism are expressed. Furthermore, the health-promoting aspect of friendly and supportive relationships might be a consequence of repetitive exposure to nonnoxious sensory stimulation causing the physiological endocrine and behavioral changes just described.

Atrial natriuretic hormone inhibits corticotropin-releasing hormone-induced prolactin release in man

Atrial natriuretic hormone (ANH) is found in heart myocytes, and also in the CNS. The inhibitory action of ANH on the hypothalamic-pituitary-adrenocortical (HPA) system has been established by in vivo and in vitro experiments, and could be of considerable importance: whereas several synergists to corticotropin-releasing hormone (CRH), the key hormone of the HPA system, are characterized in the past, until now ANH seems to be the only peptide which counterbalances the effects of CRH at the pituitary. As well as at the corticotroph, CRH has a stimulatory influence upon the lactotroph in vivo, and like ACTH and corticosteroids prolactin (PRL) is released in response to physical and cognitive challenges. To test the hypothesis of whether ANH also inhibits the CRH-mediated prolactin release a randomized, placebo-controlled, double-blind study in 12 males aged from 25 to 30 years was conducted. With regard to the diurnal variation of the HPA system activity we compared the prolactin release by 100 micrograms hCRH during a 30 min infusion of placebo, 150 micrograms ANH or 3 IU arginine vasopressin in the morning (08:00 h) and evening (19:00 h). Evaluation of morning and evening effects revealed that administration of hCRH led to a prompt rise of plasma PRL concentration. Infusion of ANH resulted in a significantly reduced maximum increment of PRL compared to placebo (0.83 +/- 0.87 vs 2.85 +/- 1.57 ng/ml, mean +/- SD, n = 12, p < .001). In addition, the AUC values were significantly lower under ANH than in the placebo condition. Infusion of AVP did not significantly change the PRL response to CRH vs placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary catecholamine excretion in sexually abused girls

OBJECTIVE

The objective of this study was to examine urinary catecholamine excretion in a self-selected sample of sexually abused and demographically matched control girls recruited from a prospective, longitudinal study.

METHOD

Twenty-four--hour urinary catecholamine and metabolite concentrations of epinephrine, norepinephrine, dopamine, 3-methoxy-4-hydroxyphenylglycol, metanephrine, normetanephrine, vanillylmandelic acid, 3,4-dihydroxyphenylacetic acid, and homovanillic acid were measured in 12 sexually abused and 9 control girls, aged 8 to 15 years. Psychiatric profiles also were obtained.

RESULTS

The abused subjects excreted significantly greater amounts of metanephrine, vanillylmandelic acid, homovanillic acid, and total catecholamine synthesis as measured by the sum of epinephrine, norepinephrine, dopamine, and their metabolites compared to values from control subjects. When the means of all significant biochemical measures were adjusted by the covariate effect of height, only homovanillic acid and group interaction remained significant. There were positive trends toward significantly higher urinary excretion of metanephrine, vanillylmandelic acid, and total catecholamine synthesis. Sexually abused girls also had a greater incidence of suicidal ideation, suicide attempts, and dysthymia than control girls.

CONCLUSIONS

These findings support the idea that sexually abused girls show evidence of higher catecholamine functional activity compared with controls. The clinical significance of these findings in their similarity to the psychobiology of both post-traumatic stress disorder and major depressive disorder. Results from this pilot study may be of value in understanding the mechanisms of depressive and anxiety disorders and in the clinical treatment of maltreated children.

Corticotropin response to combined administration of human corticotropin-releasing hormone and small-dose arginine vasopressin in normal subjects

Arginine vasopressin (AVP) is known to potentiate corticotropin (ACTH) secretion by human corticotropin-releasing hormone (hCRH), and a combined administration of hCRH and AVP appears useful as a pituitary ACTH reserve test. This study was designed to evaluate the appropriate dose of AVP and its route of administration, for better estimation of pituitary ACTH reserve in humans, when used in combination with a conventional hCRH stimulation test. First, intravenous (IV) doses of hCRH (100 micrograms) and AVP (0, 0.1, and 0.3 U) were administered simultaneously in six normal subjects. Second, IV hCRH was administered with intramuscular (IM) AVP (0, 1.0, 3.0, and 5.0 U) in 10 normal subjects. Blood samples for measurement of plasma ACTH were obtained at 0, 15, 30, 45, 60, 90, and 120 minutes after the hCRH with and without AVP administration. The order of AVP doses was randomly chosen in each subject. The peak plasma ACTH level was 65.0 +/- 16.0 pg/mL (30 minutes) with hCRH alone and 139.5 +/- 35.6 pg/mL (15 minutes) with hCRH plus 0.3 U IV AVP in six normal subjects. Similarly, the peak plasma ACTH level was 43.5 +/- 5.6 pg/mL (30 minutes) with hCRH alone and 116.0 +/- 19.6 (15 minutes) and 96.6 +/- 24.0 pg/mL (15 minutes) with hCRH plus 3.0 and 5.0 U IM AVP in 10 normal subjects, respectively. The hCRH-induced ACTH responses (delta ACTH) with both IV and IM AVP were significantly (P less than .05) greater than the respective control values with hCRH alone. The responses (delta ACTH) were comparable between the two phases of 3.0 and 5.0 U IM AVP.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma corticotrophin releasing factor and vasopressin responses to exercise in normal man

OBJECTIVE

To evaluate the hypothalamo-pituitary-adrenal (HPA) response to both mild and intense exercise.

DESIGN

Maximum oxygen consumption (VO2max.) was initially determined. Exercise to 20% (mild) and 90% (intense) VO2max. was undertaken in random order. Subjects were exercised over a 5-minute period to the required level of intensity, which was maintained for a further 10 minutes.

SUBJECTS

Six trained male athletes.

MEASUREMENTS

Brachial vein blood was sampled before and at 5-minute intervals during and after exercise and assayed for plasma cortisol, ACTH, arginine vasopressin (AVP), corticotrophin releasing factor (CRF), sodium and lactate levels. Haemoglobin and haematocrit were measured before and at the end of exercise. Heart rate was monitored continuously and blood pressure measured whenever blood was sampled before and after exercise.

RESULTS

Maximum heart rate was 184 +/- 2 and 82 +/- 5 (mean +/- SEM) beats per minute at 90 and 20% VO2max. respectively. Plasma volume fell by 8.7 +/- 2.4% with intense exercise. Significant increases in plasma concentrations of AVP, ACTH and cortisol, but not CRF, occurred during intense exercise. Plasma sodium concentration, which increased during intense but not mild exercise, peaked at 10 minutes after the onset of exercise and preceded the rise in plasma AVP. The AVP peak clearly preceded the ACTH peak in two subjects and occurred synchronously with it in three subjects.

CONCLUSION

These results indicate that although significant HPA activation occurs during intense exercise, CRF does not appear to play a major role in mediating the ACTH response to an acute episode of vigorous exercise in man. AVP may be more important in this regard.

Cellular localization of corticotropin releasing factor mRNA in the ovine brain

In this study in situ hybridization histochemistry was used to determine the regional distribution and cellular localization of corticotropin releasing factor (CRF) mRNA in the sheep brain. The highest densities of labelled cell bodies were found in the paraventricular nucleus (PVN) of the hypothalamus and in the inferior olivary nuclei in the brain stem. Labelled cells were also found in every major cortical field as well as in the vicinity of the locus coeruleus and parabrachial nucleus and nucleus of the solitary tract. No CRF mRNA-expressing cells were found in the supraoptic nucleus or other diencephalic nuclei or in telencephalic and mesencephalic nuclei. The dense population of CRF mRNA-expressing cells in the PVN support the major role of CRF in the modulation of adrenocorticotropin (ACTH) and cortisol secretion. Moreover, the widespread distribution of CRF mRNA transcripts would suggest that there are distinct populations of CRF neurons with extrahypophysiotropic roles involved in the coordination and integration of endocrine, autonomic and behavioural responses in response to stress as well as in the control of complex cognitive and motor tasks.

Safety and side effects of human and ovine corticotropin-releasing hormone administration in man

Synthetic human and ovine corticotropin-releasing hormone (hCRH, oCRH) are commonly used as a diagnostic tool of the hypothalamo-pituitary-adrenal axis. In this paper reports about side effects after various modes of CRH-application are analyzed and compared to our corresponding data of human studies with hCRH and oCRH. Generally, CRH is well tolerated after single administration and interval-application of standard doses, although minor side effects appear sometimes after higher doses (greater than 200 micrograms hCRH, oCRH) of CRH-bolus-injections. Predominantly the cardiovascular system (e.g. tachycardia, hypotension, flushing) is affected; neuropsychological symptoms are only seen sporadically (e.g. dizziness). Long term continuous infusion (several hours) of low CRH-doses (hCRH, oCRH) are well tolerated but side effects appear (see above) when cumulated doses of 200 micrograms-300 micrograms/h are given. Standard doses of hCRH and oCRH are also well tolerated in severely ill patients; it has to be considered that higher doses may provoke marked side effects in persons with neurologic disorders, in subjects with coronary heart disease and in patients with endocrinological disorders of the pituitary-adrenal axis, especially in those subjects in whom the blood-brain-barrier may have been damaged (e.g. head injury, intracranial operation). Single hCRH- and oCRH-bolus-injections in standard doses have a very low rate of complications, "non-standard" doses should provisionally be used only in clinical studies with well designed safety-precautions.

Ovine corticotropin releasing hormone stimulation test: normal value study

We determined the pituitary-adrenal response to 1 microgram/kg of ovine corticotropin releasing hormone (oCRH) administered as an intravenous bolus injection in 50 normal subjects. Brief facial flushing was noted in 44% of the subjects; no other side effects were reported. Plasma corticotropin levels increased from a median of 30.2 pg/ml at baseline to a median peak level of 77.8 pg/ml after administration of oCRH; the peak response occurred at the 30- to 45-minute or the 45- to 60-minute time point. Plasma cortisol levels increased from a median of 10.8 micrograms/dl at baseline to a median peak level of 22.0 micrograms/dl after administration of oCRH; the peak response occurred at the 45- to 60-minute time point. Plasma beta-endorphin levels increased from a median of 9.5 pg/ml at baseline to a median peak level of 23.0 pg/ml after administration of oCRH; the peak response occurred at the 15- to 30-minute or the 30- to 45-minute time point. The responsiveness to oCRH was unaffected by age, sex, or body mass index of the subjects.

Arginine vasopressin in Cushing's disease

Bilateral simultaneous blood samples were taken from the inferior petrosal sinuses of nine patients with Cushing's disease for measurement of adrenocorticotropin (ACTH), vasopressin (AVP), prolactin, growth hormone, luteinising hormone (LH), and follicle stimulating hormone (FSH). Inter-sinus gradients for ACTH (range 3.3-18.2) and AVP (2.0-375) correctly lateralised the microadenoma in seven of these patients. One additional patient showed an increased gradient for AVP but not ACTH on the side of the tumour. The correlation between the AVP and ACTH concentrations in the petrosal sinus draining the microadenoma was significant. Petrosal sinus plasma concentrations of prolactin and growth hormone were also significantly higher on the side of the tumour than on the non-tumour side. Evidence against a non-specific tumour effect on the secretion of all pituitary hormones was the fact that in most cases the gradients for LH and FSH were not significant. It is proposed that increased delivery of AVP to part of the pituitary may result from an aberrant blood supply, and that AVP may interact with corticotropin releasing factor to promote tumour growth and ACTH release.

Effect of corticotropin-releasing factor on the electrical and mechanical activities of the guinea-pig ventricular myocardium

1. The effects of the physiological levels of corticotropin-releasing factor (CRF) on isolated guinea-pig ventricular myocardium were studied using a force transducer and standard microelectrode techniques. 2. CRF increased the contractile force of muscles concentration-dependently in normal Tyrode and a high-K+ (27 mM) solution. The positive inotropic effect of CRF was associated with a significant enhancement of the slow action potentials of partially depolarized muscles in high-K+ solution. CRF potentiated the effect of increasing Ca2+ concentration of Tyrode solution. 3. The inotropic effect of CRF was reduced in the presence of diltiazem, and suppressed by phentolamine, metoclopramide, and cimetidine, but was not affected by propranolol and cold condition. 4. It is suggested that an increase in the slow inward Ca2+ current induced by CRF plays an important role in its positive inotropic effect and that its effect differs from that of cardiotonic steroids.

Plasma N-POMC, ACTH and cortisol following hCRH administration in major depression and dysthymia

The concentrations of plasma N-terminal pro-opiomelanocortin, adrenocorticotropic hormone and cortisol in response to a 14:30 h human corticotrophin releasing hormone (hCRH) stimulation test (1 microgram/kg) were measured in control, major depression and dysthymic subjects. The increases in all three hormones were similar in the depressed groups when compared to the control values. The elevation in cortisol after hCRH was significantly greater in major depression when compared to the dysthymic subjects. The significance of these findings is discussed.

The pituitary-adrenal response to CRF-41 is unaltered by intravenous somatostatin in normal subjects

We have previously reported that the hypothalamo-pituitary-adrenal response to insulin-induced hypoglycaemia is normal while the cortisol release to pituitary stimulation by corticotrophin releasing factor (CRF-41) is reduced in obesity. Impaired growth hormone (GH) secretion is also found in obesity which may result from altered central levels of somatostatin (SMS). We have investigated, by giving a simultaneous infusion of SMS to six volunteer normal weight men during a CRF test, whether it is possible for SMS to modify pituitary-adrenal function. Each subject received intravenous CRF-41 (0.5 micrograms/kg) on two occasions during an infusion of isotonic saline or SMS (4 micrograms/min) in a randomized double-blind study. Plasma GH, cortisol, ACTH and SMS were measured. Three subjects demonstrated GH peaks during saline infusion but no peaks were seen in any subject during SMS infusion. No significant difference was found between peak cortisol responses during saline or SMS infusion (SMS cortisol 443 +/- 61 nmol/l, saline cortisol 485 +/- 52 nmol/l); neither was there any difference in the ACTH responses. We conclude that SMS does not alter the pituitary response to CRF in normal weight men and is thus less likely to be responsible for the altered pituitary-adrenal function seen in obesity. Further studies of alternative mechanisms are required to explain the cause of this abnormality.

Effect of beta-adrenergic blockade on hormonal responses during continuous and intermittent exercise

The modifying effect on exercise performance and neuroendocrine response of the nonselective beta blocker timolol (10 mg b.i.d. for 5 days) and the beta 1-selective beta blocker metoprolol (100 mg b.i.d. for 5 days) was studied. The hormones studied were growth hormone, prolactin, cortisol, renin, epinephrine, dopamine, and norepinephrine. The response was studied during short-term maximal dynamic exercise, using two different exercise protocols; continuous (n = 11) and intermittent (n = 9) bicycle ergometry, in normal healthy young men. Accumulated work on placebo was nearly identical in the two studies, but was significantly reduced by 10.4% and 6.6% with timolol and by 4.7% and 6.7% with metoprolol, during continuous and intermittent exercise, respectively. During continuous exercise, accumulated work was 5.8% lower (p less than 0.05) with timolol than with metoprolol. The hormonal plasma concentrations of all hormones except renin were higher during continuous exercise than during intermittent exercise. Beta blockade had no effect on baseline hormonal levels, but the response was markedly changed during exercise. Maximum epinephrine, cortisol, and prolactin responses increased after beta blockade; dopamine remained nearly unchanged; while the renin responses were attenuated. Norepinephrine concentrations were slightly increased during continuous exercise by beta blockade and rose in direct proportion to the increase in workload. During intermittent exercise, maximum norepinephrine levels were significantly reduced by beta blockade compared with placebo. Thus the effect of beta 1-selective and nonselective beta receptor blockade on circulating hormones does not seem to explain the reduced exercise capacity following beta blockade.

The effect of ovine corticotrophin-releasing factor on the hormonal response to insulin-induced hypoglycaemia

In order to investigate the role of hypothalamic corticotrophin-releasing factor (CRF41) in the mediation of the pituitary ACTH response to hypoglycaemia, eight normal adult males were studied on four occasions. Commencing at 0830 h after an overnight fast, each received, in double-blind, random order, intravenous boluses of: A, normal saline control; B, soluble insulin 0.15U/kg; C, ovine CRF41 (oCRF41) 100 micrograms; D, soluble insulin 0.15U/kg followed immediately by oCRF41 100 micrograms. Adequate hypoglycaemia (blood glucose less than 2.2 mmol/l) was achieved in each subject when insulin was given alone or with oCRF41, and there was no difference in the glucose nadir between the 2 days. Peak plasma ACTH was significantly higher after insulin plus oCRF41 than after insulin alone (P less than 0.05) or oCRF41 alone (P less than 0.01) and this enhancement of ACTH release was most marked in the first phase of the response at 30 min (P less than 0.001, b vs d). There was no difference in the peak serum cortisol response whether oCRF41 and insulin were given alone or together and although the area under the cortisol curve was greater after insulin plus oCRF41, this difference was explicable simply on the basis of the earlier onset of the cortisol response to oCRF41. There were no differences in the serum GH responses to hypoglycaemia on the 2 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Pituitary-adrenal responses to CRH and insulin hypoglycemia in patients with idiopathic GH deficiency

It is well known that the activation of the hypothalamus-pituitary-adrenal axis (HPA) by insulin-induced hypoglycemia (IIH) is more potent and multifactorial than that caused by CRH administration. In this study we compared the clinical value of both tests in assessing the integrity of the HPA system. Plasma ACTH and cortisol responses to oCRH (1 microgram/kg iv) and IIH (insulin 0.1 U/kg iv, glycemia less than 40 mg/dl) were compared in 15 patients with idiopathic GH deficiency. The CRH-induced mean ACTH response was lower, but not significantly, in patients than in controls (peak: 8.8 +/- 1.7 vs 13.4 +/- 2.2 pmol/l), while the mean cortisol response was significantly lower than in normals (peak: 585.7 +/- 49.5 vs 764.5 +/- 52.2 nmol/l, p less than 0.005). Plasma ACTH and cortisol responses to IIH were significantly lower than in normal subjects (peak: 22.3 +/- 5.3 vs 35.8 +/- 5.2 pmol/l, p less than 0.05 and peak: 566.5 +/- 55 vs 803 +/- 38.5 nmol/l, p less than 0.02, respectively). Both in controls and in patients the CRH-induced mean ACTH response was significantly lower (p less than 0.02) than that after insulin, while cortisol peaks were not different. In conclusion, in patients with GH deficiency the impairment of ACTH secretion is not evident in basal condition, but it is disclosed after appropriate dynamic tests. It is confirmed that insulin hypoglycemia is a more potent stimulus than CRH for ACTH release.

Hypothalamic hypogonadism following major head injury

Endocrine studies, using the four hypothalamic releasing hormones, gonadotrophin releasing hormone, thyrotrophin releasing hormone, corticotrophin releasing hormone and growth hormone releasing hormone, were performed in 33 males after admission with a major head injury. The test was repeated 7 days later in all 33 patients and after 3-6 months in 21 patients. All patients had a period of unconsciousness followed by post-traumatic amnesia of greater than 24 h. The results obtained from investigating the gonadal axis are reported in this paper. The levels of total and free testosterone, basal FSH and basal LH fell significantly during the first 3 days after injury, when the LH and FSH responses to GnRH achieved their highest peak levels. This hormone pattern has not previously been reported in the gonadal axis and may be a consequence of hypothalamic dysfunction. The severity of the injury was negatively correlated to the testosterone concentration on admission and to the basal and peak FSH concentrations 1 week later. Persistent hypogonadism was found in five of the 21 patients retested after 3-6 months, with low testosterone concentrations and three continued to have an exaggerated LH response to GnRH. Thus major head injury frequently results in hypogonadism shortly after injury, with an increased gonadotrophin response to GnRH. In addition, a substantial minority of patients continue to be hypogonadal after 3-6 months. In view of these findings we strongly suggest that all patients should be endocrinologically assessed at intervals following severe head injury.

CRF in the differential diagnosis of Cushing's syndrome: a comparison with the dexamethasone suppression test

Accurate differential diagnosis of the precise cause of Cushing's syndrome can be difficult, and conventional tests such as those based on the use of dexamethasone may be misleading. We have therefore studied the cortisol and ACTH responses to ovine corticotrophin-releasing factor (CRF-41) in 28 consecutive patients with Cushing's syndrome, and compared the diagnostic value of this test with that of the high-dose dexamethasone suppression test (8 mg/day for 48 h). Of 20 patients with confirmed Cushing's disease (pituitary-dependent Cushing's syndrome), only 16 (80%) showed the expected 50% or more suppression of serum cortisol following high-dose dexamethasone administration. Four patients each with adrenal adenomas and three patients with the ectopic ACTH syndrome failed to suppress, while a child with probable Cushing's disease showed a variable response depending on the dose used. Following CRF stimulation, 15 out of the 20 patients (75%) with Cushing's disease showed an excessive rise in serum cortisol, outside the normal range, while in five the response to CRF-41 was normal on at least one occasion. None of the patients with adrenal adenomas or the ectopic ACTH syndrome showed a cortisol response to CRF. Thus, either test on its own may be misleading in differentiating Cushing's disease from other causes of the syndrome. Every patient with Cushing's disease, however, showed either suppression in response to high-dose dexamethasone or an excessive cortisol response to CRF testing. It appears, therefore, that the combination of the high-dose dexamethasone and the CRF test, with measurement of serum cortisol, is superior to either test alone in the differential diagnosis of Cushing's syndrome.

Selective bilateral and simultaneous catheterization of the inferior petrosal sinus: CRF stimulates prolactin secretion from ACTH-producing microadenomas in Cushing's disease

Bilateral, selective and simultaneous catheterization of the inferior petrosal sinus with measurements of ACTH after stimulation with ovine corticotrophin-releasing factor (CRF) is now frequently used to establish the differential diagnosis in patients with Cushing's disease and to determine the side of the microadenoma in the pituitary. To investigate whether CRF has any effect on other pituitary hormones, we also determined prolactin (PRL) concentrations in the samples obtained during this procedure. Fourteen patients under evaluation for Cushing's syndrome and one patient with a hormonally inactive pituitary tumour were catheterized. Baseline PRL levels in the peripheral veins were within the normal range before and after CRF in all patients (3.7-16.0 ng/ml). In 10 patients ACTH- and PRL concentrations lateralized to one side of the pituitary and could both be stimulated by CRF. The gradient of PRL between inferior petrosal sinus and periphery ranged from 7 to 147 ng/ml after CRF. There was no correlation between ACTH and prolactin increase in response to CRF. In three patients with no ACTH-gradient but a positive response to CRF, no tumours could be found during transsphenoidal surgery; they had no PRL-gradient and showed no PRL response to CRF. One patient with the ectopic ACTH syndrome had no ACTH- and no PRL response to CRF. The patient with the inactive pituitary tumour showed a normal ACTH-, but no PRL response to CRF. These data demonstrate for the first time that in normo-prolactinaemic patients with Cushing's disease, in contrast to patients bearing no microadenoma, PRL is secreted in response to CRF.(ABSTRACT TRUNCATED AT 250 WORDS)

Methodological aspects of hCRF-stimulated ACTH and cortisol secretion in healthy subjects

This study, aimed at clarifying some methodological problems of the hCRF stimulation test, was performed on 12 healthy male volunteers. ACTH and cortisol increases after 30 min and their maximum increase proved to be highly reliable response parameters for the net area under the response curve of both hormones. An influence of baseline hormone values on the maximum response was apparent for cortisol but not for ACTH. Cortisol, but not ACTH, revealed a stable test-retest reliability. There were no correlations between ACTH and cortisol responses to hCRF.

Corticotropin releasing factor activity of CRF 41 in normal man is potentiated by angiotensin II and vasopressin but not by desmopressin

Multiple hypothalamic factors seem to influence ACTH release. In vitro and/or in vivo animal models have shown that angiotensin II, vasopressin and some of its analogs are ACTH secretagogues capable of potentiating the corticotropin releasing activity of CRF41. Since these effects are controversial in man, we investigated in 3 groups of volunteers the corticotropin releasing activity of a 2h-infusion of angiotensin II (7 ng/kg/min), vasopressin (1 ng/kg/min) and desmopressin (1 ng/kg/min) given alone or in combination with a bolus injection of 100 micrograms CRF41 by measuring plasma concentrations of ACTH, cortisol, dehydroepiandrosterone and delta 4-androstenedione. Given alone angiotensin II and desmopressin had no significant effect in contrast to vasopressin which increased significantly the ACTH and steroid levels. Angiotensin II and vasopressin were both able to potentiate the corticotropin releasing activity of CRF41, whereas desmopressin was unable to produce such a potentiation. These results suggest that in man vasopressin and angiotensin II may well regulate the responsiveness of the pituitary-adrenal axis in various physiological or pathophysiological situations.

Modulatory effects of corticotropin-releasing factor on the delayed corticosteroid feedback in humans: implications of feedback sites

We recently demonstrated the presence of a delayed phase of glucocorticoid feedback on nonstress-induced ACTH secretion in normal volunteers. In this study, we investigate the effects of corticotropin-releasing factor (CRF) on that delayed feedback pathway with an attempt to determine the sites on which glucocorticoid exerts its delayed feedback effects. Thirty normal subjects were subjected to study and each subject received a single midnight dosage of 30 mg/kg BW metyrapone before each test. The whole experiment was divided into two studies. In study I, we found that ovine CRF (oCRF) 1 microgram/kg BW alone as an IV bolus injection caused an increase in the plasma ACTH level, which persisted for at least 120 minutes. Continuous infusion of cortisol 25 mg/h alone for two hours produced a significant decrease in the plasma ACTH level; this fall of ACTH began 30 minutes after the onset of cortisol administration. When IV bolus injection of oCRF 1 microgram/kg BW and the continuous infusion of cortisol 25 mg/h for two hours were both given, the plasma ACTH level increased firstly and then decreased 60 minutes after the onset of cortisol administration, progressing thereafter to the end of the study. Study II showed in those who received the IV bolus injection of human CRF (hCRF) 100 micrograms and the continuous infusion of cortisol 25 mg/h for two hours, the plasma ACTH level increased firstly and began to decline 45 minutes after the onset of cortisol administration, progressing thereafter to the end of the test.(ABSTRACT TRUNCATED AT 250 WORDS)

Potentiation of the hCRF-induced release of ACTH in man by an opioid antagonist

Administration of synthetic human corticotropin-releasing factor (hCRF; 2 micrograms/kg body weight) to six normal male subjects produced a significant rise in plasma ACTH, followed by an increase in circulating cortisol. Simultaneous treatment with the opioid antagonist naloxone (1.6 mg i.v. bolus, followed by an infusion at a rate of 1.2 mg/h) significantly potentiated the hCRF-induced rise in ACTH and enhanced the cortisol response to hCRF. It is suggested that naloxone acts by antagonizing an inhibitory ultra-short-loop feedback effect of coreleased beta-endorphin on pituitary corticotrophs, thereby amplifying the net effect of hCRF, i.e., the release of ACTH.

Inhibitory influence of corticotropin releasing factor on components of sexual behaviour in the male rat

Acute microinfusions of ovine corticotropin releasing factor (CRF) into the third cerebral ventricle (III vent.) of sexually experienced male rats produced a dose-dependent suppression of masculine sexual behaviour. This inhibition of male sexual performance induced by CRF could be reversed by simultaneous infusions of naloxone, the opiate receptor antagonist, which when infused without CRF facilitated copulatory performance. These findings suggest that CRF can exert drastic effects on male reproductive behaviour through mechanisms which involve the activation of opioid pathways within the central nervous system. This CRF-linked neurochemical signal may mediate some of the well-known deleterious effects of stressful and noxious stimuli on reproductive function.

An analogue of met-enkephalin attenuates the pituitary-adrenal response to ovine corticotrophin releasing factor

The met-enkephalin analogue, DAMME, suppresses the pituitary-adrenal axis in normal subjects; it is not clear whether this occurs at the level of the pituitary or above. We therefore administered synthetic ovine corticotrophin releasing factor (CRF-41) 100 micrograms i.v. to a group of normal male subjects, with or without pretreatment with DAMME 250 micrograms i.v., and monitored the response of plasma ACTH and serum cortisol. CRF-41 caused a marked stimulation of ACTH and cortisol release, but this was significantly attenuated by pretreatment with DAMME. It is therefore concluded that DAMME either directly inhibits the corticotroph at the level of the pituitary, or that it suppresses release of an additional factor which normally potentiates the action of CRF-41 on the pituitary.

Human corticotropin-releasing factor (hCRF) is a potent respiratory analeptic. Physiological and clinical aspects

During intravenous corticotropin-releasing factor stimulation tests we observed a deepening of the tidal volume in 35 patients. To investigate this presumed respiratory stimulation we measured respiratory parameters in 12 healthy male volunteers in a single-blind placebo-controlled trial. The intravenous 60-s infusion of 100 micrograms of human corticotropin-releasing factor induced a very potent respiratory stimulation in every subject: respiratory minute volume (mean +/- S.D.) increased by 81% from 6.319 +/- 0.577 to 11.464 +/- 1.264 liters per min (P less than 0.001), whereas there was only a slight rise in the mean respiratory rate from 12.4 +/- 3.0 to 14.7 +/- 2.7 breaths per min (P less than 0.001). Mean tidal volume increased from 531 +/- 105 to 809 +/- 175 ml (P less than 0.001). Mean end-tidal partial pressure of carbon dioxide decreased (P less than 0.001) from 40.3 +/- 1.2 to 33.4 +/- 1.2 mmHg, whereas mean end-tidal partial pressure of oxygen increased (P less than 0.001) from 93.2 +/- 5.4 to 113.5 +/- 5.4 mmHg. After 10 to 20 min both end-tidal carbon dioxide and oxygen partial pressures returned to the baseline values. The placebo had no measurable effects. We conclude that human corticotropin-releasing factor is a potent respiratory stimulant. With 100 micrograms the resting respiratory minute volume increases by 81%. These data point to the possible importance of the corticotropin-releasing factor as a useful adjunct in the management of patients with alveolar hypoventilation.

The effect of ovine corticotrophin releasing factor (oCRF), bromocriptine and TRH on the secretion of ACTH and alpha-MSH in Nelson's syndrome and Cushing's disease

The circulating levels of ACTH and alpha-melanocyte stimulating hormone (alpha-MSH) were measured in 9 patients with Nelson's syndrome after the administration of saline, ovine corticotrophin releasing factor (oCRF), bromocriptine or TRH. The concentrations of ACTH were grossly elevated and alpha-MSH levels ranged from undetectable to higher than the normal range. In seven of eight subjects there was a rapid corticotrophic response, but no change in the alpha-MSH level, following oCRF. This response was delayed in one subject. Following oCRF injection, the plasma oCRF profile was variable but circulating oCRF was detectable even at the end of the experiment in all cases. There was no significant change in circulating ACTH or alpha-MSH following either bromocriptine or TRH. Cultured tumour cells from one case of Cushing's disease showed a corticotrophic response but no change in alpha-MSH to oCRF and the response was enhanced by vasopressin. Bromocriptine added to the same tumour depressed ACTH secretion without affecting the output of alpha-MSH. The present data suggest that the tumours in these subjects are responsive to oCRF and arise from corticotrophs rather than melanotrophs.

Sympatho-adrenal medullary functions in response to intracerebroventricularly injected corticotropin-releasing factor in anesthetized rats

Effects of intracerebroventricular (i.c.v.) administration of corticotropin-releasing factor (CRF) on adrenal sympathetic efferent nerve activity, adrenal catecholamine secretion rate and cardiovascular function (i.e. blood pressure, heart rate and renal nerve activity) were investigated in halothane-anesthetized rats. Administration (i.c.v.) of CRF resulted in a dose-dependent increase (to 140% of control, for a 6.4 nmol dose) in adrenal sympathetic nerve activity which began several minutes after injection and reached maximum values approximately 30-60 min later. This increase was significant, when tested against vehicle injected controls, for doses of 6.4 nmol and 640 pmol; however, a 64 pmol dosage did not produce significant effects. Acute hypophysectomy did not influence the response of adrenal nerve activity to i.c.v. injection of CRF. Intravenous administration of CRF (6.4 nmol) did not produce any significant increases in ongoing activity of the adrenal nerve. Following i.c.v. administration of CRF (640 pmol), epinephrine and norepinephrine secretion, as measured from adrenal venous blood samples, showed a similar response pattern to that of the adrenal nerve. Significant increases (maximum increases, from 13.2 to 31.5 ng/kg/min and from 4.1 to 8.6 ng/kg/min for epinephrine and norepinephrine secretion rates, respectively) were observed over the 90 min blood sampling period. The present study demonstrates by direct recording of adrenal sympathetic nerve activity and measurement of adrenal catecholamine secretion rate, that i.c.v. administered CRF can increase adrenal sympathetic efferent nerve activity resulting in increases in catecholamine secretion. In addition, renal nerve activity also showed dose-dependent increases after CRF i.c.v. administration (to 160% of control, for a 6.4 nmol dose) as did heart rate (increases of 35 beats/min for a 6.4 nmol dose).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative effects of corticotropin-releasing factor, arginine vasopressin, and related neuropeptides on the secretion of ACTH and alpha-MSH by frog anterior pituitary cells and neurointermediate lobes in vitro

The ability of corticoliberin (CRF), urotensin I, sauvagine, arginine-vasopressin (AVP), and mesotocin to stimulate ACTH release by frog anterior pituitary cells and alpha-melanotropin (MSH) by frog neurointermediate lobe was studied in vitro using a perifusion technique. CRF and AVP were found to be potent stimulators of ACTH secretion, whereas urotensin I and sauvagine were totally inactive. In opposition to recent findings in the rat. CRF did not modify alpha-MSH secretion by the frog neurointermediate lobe. Mesotocin, which is present in the parenchymal cells of the frog pars intermedia, had no effect on alpha-MSH release in vitro. No potentiation of CRF-induced ACTH release was observed when anterior pituitary cells were incubated with a combination of AVP and CRF. Together with the recent elucidation of a CRF-like molecule in the frog diencephalon, these results suggest that, in Amphibia, CRF and AVP exert their stimulatory action specifically on distal lobe corticotrophs.

Combined use of vasopressin and synthetic hypothalamic releasing factors as a new test of anterior pituitary function

Nine normal volunteers and 15 patients with pituitary disorders were given a combined test of anterior pituitary function using four hypothalamic releasing factors and arginine vasopressin. Rapid sequential intravenous infusions of human corticotrophin releasing factor 100 micrograms, growth hormone releasing factor 100 micrograms, luteinising hormone releasing hormone 100 micrograms, and thyrotrophin releasing hormone 200 micrograms were administered. Arginine vasopressin (10 pressor units) was given intramuscularly at the same time. Plasma or serum samples were assayed for concentrations of cortisol, growth hormone, luteinising hormone, follicle stimulating hormone, prolactin, and thyroid stimulating hormone at multiple times for 120 minutes. No troublesome side effects occurred. The results of the releasing factor combined test with arginine vasopressin were compared in the same subjects with a conventional combined test using insulin together with thyrotrophin releasing hormone and luteinising hormone releasing hormone. No difference was observed in the basal and peak concentrations of luteinising hormone, follicle stimulating hormone, thyroid stimulating hormone, and prolactin. Both cortisol and growth hormone responses to the releasing factors with arginine vasopressin were much greater than those seen with insulin induced hypoglycaemia or the combined releasing factors without arginine vasopressin. Patients with pituitary hypo-function were similarly recognised in both studies. There was a rapid increase in all hormone values with a peak usually by 60 minutes. In most people adequate assessment of individual hormone reserves may be achieved using basal, 30 minute, and 60 minute samples. This new combined releasing factor test appears to be a safe, rapid, and useful test of anterior pituitary function.

Corticotropin-releasing factor receptors in the pituitary gland and central nervous system: methods and overview

Studies with the radioiodinated oCRF analog, Nle21, 125I-Tyr32-oCRF have identified, characterized, and localized high affinity binding sites for CRF in anterior and intermediate lobes of rat pituitary, in anterior lobe of human pituitary, and in rat, monkey, and human brain. The pharmacology and distribution of Nle21, 125I-Tyr32-oCRF binding in the pituitary gland correlate well with the biological potency and sites of action of CRF and suggest that these CRF binding sites represent specific receptors that mediate the well-established actions of CRF on the anterior pituitary and on the intermediate lobe of the pituitary. The studies in adrenalectomized rats demonstrating that endogenous CRF is capable of modulating its receptor density provide additional evidence that the radioligand labels the functional CRF receptor. The areas of distribution of Nle21, 125I-Tyr32-oCRF binding sites in the rat CNS correlate well with the immunohistochemical distribution of CRF pathways and the pharmacological sites of action of CRF. These data confirm the established role of CRF in regulating secretion of POMC-derived peptides from the pituitary gland. In addition, the data support a physiological role for endogenous CRF in regulating CNS activity and suggest the importance of this neuropeptide in integrating endocrine and visceral functions and behavior, especially in response to stress. Studies to characterize CRF receptors and CRF-containing pathways in the brain provide a means for better understanding the various functions of this neuropeptide in different areas of the CNS. Finally, the ability to map CRF receptors in postmortem human tissue provides a basis for studying the role of CRF in a variety of endocrine, neurological, and psychiatric disorders.