RESUMEN
Out of all steroidogenesis inhibitors aminoglutethimide is most frequently used agent for so-called chemical adrenalectomy, especially in oncological cases. The present studies aimed at assessing an effect of the inhibition of cortisol synthesis on plasma ACTH in patients treated with aminoglutethimide. According to the rules of negative feedback, an increase in plasma ACTH should be expected. Aminoglutethimide has been administered to 24 patients with Cushing's disease for 1-6 months. Plasma ACTH did not increase but statistically significantly decreased despite a decrease in blood cortisol. It indicates that aminoglutethimide directly inhibits ACTH secretion. No return of the normal circadian rhythm of cortisol and ACTH release suggests that the drug exerts an effect on ACTH release regulating mechanisms. No definite results were achieved in patients with Nelson syndrome treated with aminoglutethimide for a short period of time. Plasma ACTH levels tend to decrease but no statistical significance was observed in comparison with placebo. It may depend on markedly increased corticotrophin secretion in Nelson tumors.
Asunto(s)
Hormona Adrenocorticotrópica/sangre , Aminoglutetimida/farmacología , Síndrome de Cushing/tratamiento farmacológico , Síndrome de Nelson/tratamiento farmacológico , Adolescente , Adulto , Síndrome de Cushing/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Nelson/sangreAsunto(s)
Hormona Adrenocorticotrópica/sangre , Síndrome de Cushing/sangre , Hidrocortisona/sangre , Adolescente , Adulto , Aminoglutetimida/uso terapéutico , Síndrome de Cushing/terapia , Ciproheptadina/uso terapéutico , Femenino , Humanos , Hipofisectomía , Masculino , Persona de Mediana Edad , Pizotilina/uso terapéutico , Ácido Valproico/uso terapéuticoRESUMEN
Sodium valproate, a gamma-aminobutyric acid (GABA) agonist, was found to decrease plasma ACTH concentration in some cases of Cushing's disease and Nelson's syndrome. In this study we have investigated the influence of magnesium valproate (MV), a newly introduced salt of valproic acid, on plasma ACTH levels in 8 patients with Nelson's syndrome. The daily dose, 1200 mg of MV, significantly decreased plasma ACTH level at 10 p.m. compared with placebo. A single dose of 400 mg of MV, led to a reduction in plasma ACTH concentration only in two out of seven patients during a four-hour observation. The fall in plasma ACTH level in the same patients at 10 p.m., after the next two doses of this drug, suggests that single dose may be insufficient for introducing GABA-dependent reduction in ACTH release. During a long-term therapy with MV, in all three patients investigated a marked decrease in plasma ACTH was observed. Our results suggest that magnesium valproate may be useful during chronic therapy in some patients with ACTH hypersecretion.
Asunto(s)
Hormona Adrenocorticotrópica/sangre , Síndrome de Nelson/sangre , Ácido Valproico/farmacología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Ácido gamma-Aminobutírico/fisiologíaAsunto(s)
Enfermedades de las Glándulas Suprarrenales/sangre , Hidrocortisona/sangre , Adolescente , Pruebas de Función de la Corteza Suprarrenal/métodos , Enfermedades de las Glándulas Suprarrenales/diagnóstico , Adulto , Anciano , Ritmo Circadiano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Factores de TiempoAsunto(s)
Hormona Adrenocorticotrópica/sangre , Síndrome de Cushing/tratamiento farmacológico , Hidrocortisona/sangre , Síndrome de Nelson/tratamiento farmacológico , Neoplasias Hipofisarias/tratamiento farmacológico , Ácido Valproico/uso terapéutico , Hormona Adrenocorticotrópica/antagonistas & inhibidores , Adulto , Síndrome de Cushing/sangre , Femenino , Antagonistas de Hormonas , Humanos , Hidrocortisona/antagonistas & inhibidores , Persona de Mediana Edad , Síndrome de Nelson/sangre , Inducción de RemisiónAsunto(s)
Enfermedad de Addison/sangre , Adrenalectomía , Hormona Adrenocorticotrópica/sangre , Síndrome de Cushing/sangre , Naloxona/administración & dosificación , betaendorfina/sangre , Adulto , Síndrome de Cushing/fisiopatología , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , RadioinmunoensayoAsunto(s)
Insuficiencia Suprarrenal/tratamiento farmacológico , Cortisona/administración & dosificación , Hidrocortisona/administración & dosificación , Administración Oral , Adulto , Ensayos Clínicos como Asunto , Femenino , Glucocorticoides/administración & dosificación , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Growth hormone determinations were done in the serum of 45 patients with acromegaly. In 3 cases the basal GH levels was normal, in the remaining ones it was raised. Of the functional tests those with insulin, glucose and L-Dopa were done. The tests with glucose and L-Dopa loading were found to be more useful diagnostically than the insulin test. After surgical treatment the GH level returned to its normal value in 10 cases, but in most cases it fell to at least one half of the initial value. In 5 cases with more pronounced expansion of the pituitary tumour the GH value was not significantly changed.