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dc.contributor.authorTsatsoulis, Agathocles*
dc.contributor.authorShalet, Stephen M*
dc.contributor.authorHarrison, J*
dc.contributor.authorRatcliffe, W A*
dc.contributor.authorBeardwell, Colin G*
dc.contributor.authorRobinson, E L*
dc.date.accessioned2010-11-10T10:36:51Z
dc.date.available2010-11-10T10:36:51Z
dc.date.issued1988-02
dc.identifier.citationAdrenocorticotrophin (ACTH) deficiency undetected by standard dynamic tests of the hypothalamic-pituitary-adrenal axis. 1988, 28 (2):225-32 Clin. Endocrinol.en
dc.identifier.issn0300-0664
dc.identifier.pmid2844448
dc.identifier.doi10.1111/j.1365-2265.1988.tb03659.x
dc.identifier.urihttp://hdl.handle.net/10541/115230
dc.description.abstractSix patients (four females, two males; aged 18-65 years), previously treated by external pituitary irradiation (2000-4000 cGY in 8-15 fractions over 10-20 days) for pituitary tumours, presented with the symptoms of excessive and inappropriate tiredness suggestive of ACTH deficiency, despite a normal peak cortisol response to an insulin tolerance test (four cases) or to a glucagon stimulation test (two cases). These six patients were found to have significantly lower mean 24 h urinary free cortisol levels (100 +/- 40 nmol; mean +/- SD) compared with the mean value of 31 normal controls (210 +/- 70.8 nmol; P less than 0.01). In addition serum cortisol profiles based on a series of four timed samples between 0900-2300 h were subnormal (mean 130 nmol/l) in comparison with profiles obtained from 12 normal controls (mean 270 nmol/l) (P less than 0.001). Glucocorticoid replacement therapy promptly abolished their symptoms. These results suggest that a discordance between ACTH secretion under basal circumstances and ACTH response to pharmacological tests may exist in patients with ACTH deficiency. We speculate that defective endogenous corticotrophin-releasing hormone (CRF) secretion, due to radiation-induced damage at hypothalamic level, is one cause of this phenomenon.
dc.language.isoenen
dc.subjectPituitary Canceren
dc.subject.meshAdolescent
dc.subject.meshAdrenocorticotropic Hormone
dc.subject.meshAdult
dc.subject.meshAged
dc.subject.meshFemale
dc.subject.meshGlucagon
dc.subject.meshHumans
dc.subject.meshHypothalamo-Hypophyseal System
dc.subject.meshInsulin
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshPituitary Neoplasms
dc.subject.meshPituitary-Adrenal System
dc.subject.meshRadiation Injuries
dc.titleAdrenocorticotrophin (ACTH) deficiency undetected by standard dynamic tests of the hypothalamic-pituitary-adrenal axis.en
dc.typeArticleen
dc.contributor.departmentDepartment of Endocrinology, Christie Hospital, Manchester, UK.en
dc.identifier.journalClinical Endocrinologyen
html.description.abstractSix patients (four females, two males; aged 18-65 years), previously treated by external pituitary irradiation (2000-4000 cGY in 8-15 fractions over 10-20 days) for pituitary tumours, presented with the symptoms of excessive and inappropriate tiredness suggestive of ACTH deficiency, despite a normal peak cortisol response to an insulin tolerance test (four cases) or to a glucagon stimulation test (two cases). These six patients were found to have significantly lower mean 24 h urinary free cortisol levels (100 +/- 40 nmol; mean +/- SD) compared with the mean value of 31 normal controls (210 +/- 70.8 nmol; P less than 0.01). In addition serum cortisol profiles based on a series of four timed samples between 0900-2300 h were subnormal (mean 130 nmol/l) in comparison with profiles obtained from 12 normal controls (mean 270 nmol/l) (P less than 0.001). Glucocorticoid replacement therapy promptly abolished their symptoms. These results suggest that a discordance between ACTH secretion under basal circumstances and ACTH response to pharmacological tests may exist in patients with ACTH deficiency. We speculate that defective endogenous corticotrophin-releasing hormone (CRF) secretion, due to radiation-induced damage at hypothalamic level, is one cause of this phenomenon.


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