Feedback control of vasopressin and corticotrophin secretion in conscious dogs: effect of hypertonic saline

Effect of exogenous glucocorticoid on osmotically stimulated antidiuretic hormone secretion and on water reabsorption in man

OBJECTIVE

Glucocorticoids exert tonic suppression of antidiuretic hormone (ADH) secretion. Hypocortisolism in secondary adrenocortical insufficiency can result in a clinical picture similar to the syndrome of inappropriate ADH secretion. On the other hand, in vitro and in vivo results provide evidence for ADH suppression in states of hypercortisolism. To test the hypothesis that ADH suppression is of relevance during glucocorticoid therapy, we investigated the influence of prednisolone on the osmotic stimulation of ADH.

DESIGN AND METHODS

Seven healthy men were subjected to water deprivation tests with the measurement of plasma ADH (pADH) and osmolality (posmol) before and after glucocorticoid treatment (5 days 30 mg prednisolone per day).

RESULTS

Before glucocorticoid treatment, the volunteers showed a normal test with an adequate increase of pADH (basal 0.54 +/- 0.2 to 1.9 +/- 0.72 pg/ml (mean +/- S.D.)) in relation to posmol(basal 283.3 +/- 8.5 to 293.7 +/- 6 mosmol/kg). After prednisolone intake, pADH was attenuated (<0.4 pg/ml) in spite of an increase of posmol from 289.3 +/- 3.6 to 297.0 +/- 5.5 mosmol/kg. However, urine osmolar concentration increased normally during water deprivation after prednisolone. Urinary cAMP excretion increased during water deprivation without glucocorticoid treatment from 3.56 +/- 0.55 to 6.07 +/- 0.76 micro mol/l, reflecting the increased pADH levels. The rise in cAMP excretion was completely blunted by prednisolone treatment.

CONCLUSIONS

We speculate that there may be an ADH-independent stimulation of the formation or function of aquaporin-2 channels by prednisolone and/or a direct osmotic stimulation of water reabsorption independent of ADH and glucocorticoid control.

Cortisol feedback in adrenalectomized adult sheep

These experiments tested the sensitivity of cortisol feedback on adrenocorticotropic hormone (ACTH) secretion in adult sheep. In series I, five bilaterally adrenalectomized (ADX) adult sheep were maintained on "low" (125 micrograms/h) or "high" (500 micrograms/h) intravenous cortisol replacement, and dose-response curves were obtained with corticotropin-releasing factor (CRF) and arginine vasopressin (AVP). CRF caused incremental increases in plasma ACTH at the low but not the high dose of cortisol. AVP was similarly ineffective in stimulating ACTH at the high dose of cortisol. However, in series II, where ADX animals were again maintained on low or high cortisol infusions, a combined infusion of CRF and AVP was able to stimulate a robust ACTH response during both steroid replacement regimens. These studies demonstrate that the pituitary represents a major site of steroid feedback in the sheep, with a relatively small increase in the concentration of cortisol, within the normal unstressed physiological range, being able to inhibit ACTH secretion in response to exogenous CRF and AVP. However, under these conditions, inhibition of ACTH release can be overcome by the combined action of CRF and AVP. Further studies in series III, concerned with the nature of glucocorticoid inhibition of AVP release, demonstrate that whereas exposure to maximal cortisol levels (5,000 micrograms/h) completely abolishes the ACTH response to severe hemorrhage (15 ml/kg over 15 min), AVP release is maintained, suggesting that the system controlling AVP release during hemorrhagic stress is less sensitive to the negative influences of glucocorticoids than is the system controlling ACTH release.

Chronic glucocorticoid excess and impaired osmoregulation of vasopressin release in dogs with hepatic encephalopathy

Chronic liver disease may be accompanied by disturbed sodium and water homeostasis. There is usually sodium retention and ascites. However, spontaneous natriuresis has also been reported in humans and experimental animals with liver cirrhosis. Chronic hypercortisolism, which may occur in dogs with advanced liver disease, is known to induce the inhibition of the osmostimulation of vasopressin (AVP) release. We have therefore investigated the osmoregulation of AVP release in 11 dogs with chronic hypercortisolism associated with advanced liver dysfunction and hepatic encepahlopathy and in 10 control dogs. Basal pituitary-adrenocortical activity was investigated by measuring the concentration in multiple plasma samples of adrenocorticotropin (ACTH), alpha-melanocyte-stimulating hormone (MSH), and cortisol and the cortisol:creatinine ratio in 24-hr urine. Urine specific gravity was also measured. The feedback regulation of the system was investigated by measuring these hormones in plasma after an intravenous (iv) injection of 0.01 mg/kg of dexamethasone. The osmoregulation of the release of AVP was investigated by the intravenous infusion of a 20% NaCl solution at a flow rate of 0.03 ml/kg for 2 hr and the measurement of AVP in plasma sampled at 20-min intervals. The AVP release was analyzed in terms of the threshold osmolality at which it commenced and the sensitivity, which reflects the magnitude of the response. All dogs had highly increased urinary cortisol:creatinine ratios, ranging from 21 to 210 x 10(-6) (normally < 10 x 10(-6)). The mean basal plasma concentrations of the three pituitary-adrenocortical hormones were significantly increased. ACTH values were 35 to 146 ng/l (normally, 14 to 68), MSH values were 26 to 118 ng/l (normally, 10 to 36), and cortisol values were 88 to 194 nmol/l (normally, 23 to 112). The feedback inhibition of the secretion of ACTH and cortisol in response to dexamethasone was unaffected. Urine specific gravity was significantly decreased. The regulation of AVP release was found to be abnormal in all dogs with hepatic encephalopathy. The osmotic threshold at which the release of AVP was induced was abnormally high in seven of the dogs with liver disease and in the normal range in one. It could not be determined in three dogs. The sensitivity of AVP release in response to increasing plasma hypertonicity was normal in two dogs and decreased in nine. In three dogs, there was no increase in AVP release. None of the dogs had normal values for both the sensitivity and the threshold.(ABSTRACT TRUNCATED AT 400 WORDS)

The role of central corticoliberin in the hyperosmosis-induced secretion of neurohypophysial hormones and corticosterone in the rat

Although synthetic corticotropin-releasing hormone (CRH) is known to influence the secretion of the neurohypophysial hormones, the role of endogenous CRH in the rat brain is still unclear in this respect. Accordingly, experiments were scheduled to study the effects of intracerebroventricularly (i.c.v.) administered CRH-antiserum (AS) on the hyperosmosis-induced secretion of arginine-8-vasopressin (AVP), oxytocin (OXT) and corticosterone in Wistar male rats. A 2 microliters CRH-AS injection was given, and repeated 24 h later, 30 min prior to intraperitoneal administration of hypertonic saline (HS; 2.5% NaCl, 2 ml/100 g body weight) followed by decapitation in 15 min. Plasma AVP and OXT were measured by radioimmunoassay and corticosterone by fluorimetry. HS increased the levels of AVP, OXT and corticosterone. CRH-AS did not change the plasma concentrations of these hormones in 0.9% NaCl-treated animals. CRH-AS pretreatment prevented the corticosterone-releasing action of HS, and significantly moderated the HS-induced AVP and OXT increase. These findings suggest that the central CRH system may participate in the regulation of corticosterone and neurohypophysial hormone secretion evoked by acute osmotic challenge.

Interactions between neurohypophysial hormones and the ACTH-adrenocortical axis

Figure 5 summarizes the aspects of the interaction of the HPA and magnocellular systems discussed above. Hormones classically considered confined to the magnocellular-neurohypophysial system are found in the parvocellular-long portal system and are known to be paramount in the hypophysiotropic control of ACTH release. It is now clear that hormones from the posterior pituitary can influence the secretion of ACTH via the short portal circulation and, possibly, by recirculation. There is some evidence that circulating AVP may affect adrenal sensitivity to ACTH. Corticosteroids, in addition to inhibiting parvocellular CRH and ACTH release, may inhibit the release of AVP from the neurohypophysis. The converse is also true in that patients with adrenal insufficiency may have an SIAD-like scenario. CRH may be synthesized in, and secreted from, magnocellular OT neurons and may be involved in the control of neurohypophysial function.

The role of serotonergic neurons in intravenous hypertonic saline-induced secretion of vasopressin, oxytocin, and ACTH

This study tested the effect of brain serotonin (5-HT) depletion on the secretion of oxytocin (OT), vasopressin (VP), and adrenocorticotropin (ACTH) due to an osmotic load. The 5-HT neurotoxin 5,7-dihydroxytryptamine (5,7-DHT) was used to deplete brain 5-HT. The OT, VP, and ACTH osmotic sensitivity (slope of delta[OT]/delta[Osm]) and the osmotic threshold (X intercept of delta[OT]/delta[Osm]) were evaluated. Depletion of brain 5-HT decreased the OT osmotic sensitivity by > 80% (p < 0.001) without changing the OT osmotic threshold. Brain 5-HT depletion had no effect on the VP osmotic sensitivity and increased the VP osmotic threshold from 287.8 +/- 1.5 to 293.1 +/- 2.0 mOsm/kg (p < 0.05). The plasma ACTH increase due to infusion of hypertonic saline was not affected by brain 5-HT depletion. Brain 5-HT depletion significantly (p < 0.01) decreased the pituitary content of OT and VP by 38 and 32%, respectively, without changing ACTH content. These results provide evidence for a functional role of serotonergic neurons in osmoregulation of plasma and pituitary concentration of OT and VP, but not ACTH.