The effect of intravenously-administered ACTH on plasma 17,21-dihydroxy-20-ketosteroids in normal individuals and in patients with disorders of the adrenal cortex

Effects of chronic treatment with adrenocorticotropin on adenylate cyclase activity in the adrenal cortex

The effects of prolonged administration of ACTH in vivo on adenylate cyclase activity in the zona glomerulosa (the capsular fraction) and the zona fasciculata-reticularis (the decapsulated fraction) of rat adrenocortical glands were investigated. Hyperresponsiveness of adenylate cyclase activity to ACTH in vitro was observed for both the capsular and the decapsulated fractions from ACTH-treated rats with a similar magnitude of stimulation by NaF, the guanine nucleotide or forskolin. There were no differences in binding sites for ACTH in membranes between the ACTH- and the saline-treated rats. The augmenting effects of the in vivo ACTH treatment on the enzyme stimulated by ACTH were accompanied by an increased sensitivity to the guanine nucleotide, suggesting that ACTH treatment in vivo was followed by an increased efficacy in coupling of the ACTH receptors to the adenylate cyclase complex associated with the guanine nucleotide regulatory components.

Diagnosis and evaluation of patients with an enlarged sella turcica

A prospective analysis of the roentgenographic and laboratory parameters in 100 patients with an enlarged sella turcica was made. Seventy-five patients had no visual symptoms: 27 had primary intrasellar tumor; 25 had the empty sella syndrome: 13 had an extrasellar process; and in 10, no final diagnosis was made because air study was omitted. However, these patients remained asymptomatic for up to three years. Eighteen of the patients with a primary intrasellar tumor had symptomatic pituitary dysfunction; nine were asymptomatic. Five of 14 patients studied had elevated plasmaproa prolactin levels. of the 25 patients with the empty sella syndrome and the 10 patients in whom no final diagnosis was made, none had any clinical endocrine or visual abnormalities, although in 10 of these 35 patients, results of laboratory studies were compatible with pituitary dysfunction. In these cases, air study was necessary to differentiate a clinically silent pituitary tumor from the empty sella syndrome. This emphasizes the high incidence of the empty sella syndrome in patients with enlarged sella, and also confirms the high incidence of hyperprolactinemia in patients with pituitary tumors.

Stereotactic treatment of acromegaly

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CLINICAL STUDIES UTILIZING A NEW METHOD FOR THE SERIAL DETERMINATION OF PLASMA CORTICOIDS

The clinical applications of a recently introduced method for determination of plasma corticoids were investigated with a view to its routine use in the evaluation of pituitary-adrenal problems. Simple protocols to assess the diurnal variation and the responses of the plasma corticoids to adrenocorticotropin, dexamethasone, and methopyrapone administration were adopted to study healthy subjects, chronically ill subjects free of endocrine disease, and subjects with previously diagnosed adrenal or pituitary disorders. The results in all cases were in accord with the clinical assessment of the subjects.

Cushing's syndrome

Sixteen cases of verified Cushing's syndrome, and twelve cases of probable Cushing's syndrome were reviewed and data on them were compared with various reports on Cushing's syndrome in the literature. The diagnosis hinges upon a high index of suspicion, and one or several of the major criteria may be lacking. Ultimate establishment of correct diagnosis should be based largely on the clinical features, although stimulation and suppression tests may help to confirm a clinical diagnosis. In well-established clinical cases, with borderline laboratory confirmation, exploration may be justified, especially if tests fail to identify a specific cause. In cases of adrenal cortical tumor, all pathological tissue should be removed if possible, with great care to support and stimulate the remaining atrophic adrenal gland during and following operation. In cases of bilateral adrenal cortical hyperplasia, the problem is one of how much to remove. At present most investigators advocate radical subtotal resection, leaving less than 10 per cent of one side.

THE POSSIBILITY OF CORTICOSTEROID PRODUCTION BY HUMAN AND RAT PLACENTAL TISSUE UNDER IN VITRO CONDITIONS

Human placentae obtained at Caesarean section were minced and incubated in vitro in Krebs–Ringer solution. The steroids secreted into the medium and those remaining in the tissue were measured.Seven ultraviolet light absorbing compounds were isolated from the incubation media. These included cortisone, hydrocortisone, progesterone, and four unidentified compounds. No detectable amounts of aldosterone, however, could be obtained from the quantities of tissue used.The amount of each steroid released into the incubation media decreased rapidly with time. An analysis of the original amount of each steroid present in the tissue before incubation indicated that no additional amounts of steroids were formed during the incubation periods. The addition of various steroid precursors such as progesterone, cholesterol, and Δ5-pregnene-3β-ol-20-one failed to increase the quantity of cortisone, hydrocortisone, or X1, a compound with the same chromatographic mobility as aldosterone. Placental tissue has the ability to convert hydrocortisone to cortisone and also to reduce cortisone to hydrocortisone. This tissue is capable of converting cholesterol and Δ5-pregnene-3β-ol-20-one to progesterone, the latter precursor being at least 10 times more efficient than cholesterol in this respect.The addition of the trophic hormones ACTH, HCG, and prolactin did not stimulate the production of the measured steroids under the experimental conditions employed.Rat placental tissue did not secrete aldosterone, corticosterone, or any other Δ4-3-ketonic steroids of similar polarity in measurable amounts when incubated under in vitro conditions.