Spontaneous regression of anterior pituitary deficits in a woman harboring a persistent hypothalamic mass.

Sellar or parasellar lesions can cause anterior pituitary dysfunction either by direct damage to the anterior pituitary gland or by compression of the pituitary stalk and mediobasal hypothalamus which contain the hypophysiotropic hormones. Without treatment, the pituitary deficits in such cases are not likely to improve. We describe a case in which deficits in anterior pituitary hormones spontaneously remitted in a woman who had a persistent hypothalamic lesion that was not amenable to surgery or radiotherapy. The factors that may predict spontaneous recovery of anterior pituitary function in such cases are discussed.

Neurohypophyseal secretion in response to cholecystokinin but not meal-induced gastric distention in humans.

Exogenous administration of cholecystokinin octapeptide (CCK) is known to decrease food intake and slow gastric emptying in humans and animals. Recent studies have shown that CCK stimulates neurohypophyseal secretion of oxytocin (OT) in rats and arginine vasopressin (AVP) in monkeys, and that gastric distention also stimulates OT release in rats. We therefore studied AVP and OT secretion in 14 normal subjects in response to meal-induced gastric distention and administration of CCK, both separately and in combination, to assess whether these stimuli similarly activated central neurohypophyseal pathways in humans. Neither plasma AVP nor OT concentrations increased after gastric distention produced by ingestion of a large meal. However, a dose-related increase in plasma AVP, but not OT levels, occurred after CCK administration, the threshold CCK dose being 0.05 micrograms/kg body weight. The AVP secretion in response to CCK administration was significantly correlated with subjective aversive symptoms quantified by use of a numeric scale (r = 0.61, P less than 0.001). In 12 of the 14 subjects plasma AVP levels increased in association with symptoms of epigastric pressure and discomfort before the onset of overt nausea or emesis. The combination of CCK and meal-induced gastric distention did not stimulate increases in plasma AVP levels in excess of those produced by CCK administration alone. The results demonstrate that AVP secretion resulting from emetic center activation often is a graded response that can begin in association with milder degrees of visceral discomfort before symptoms of overt nausea or emesis. In addition, the stimulation of AVP secretion by CCK administration, but not by meal-induced gastric distention in association with physiological satiety, suggests that some component of the anorectic effects of exogenous CCK in man likely results from activation of brainstem emetic centers.

Sex differences in absorption kinetics of sodium salicylate.

Sodium salicylate in aqueous solution (9 mg/kg) was given by oral and intravenous routes to normal male and female subjects. Because the bioavailability of salicylate was complete, salicylate was given orally in all subsequent experiments. There were sex differences in time required to attain peak salicylate concentration (tmax), but not in maximum plasma salicylate concentration (Cmax). There were no sex differences in apparent volume of distribution, plasma salicylate clearance, or area under the concentration-time curve. In female subjects, tmax tended to reach a nadir at the middle of the menstrual cycle, when gastric emptying time is shortest, whereas Cmax remained relatively unchanged throughout the menstrual cycle. Equilibrium dialysis studies on the binding of sodium salicylate and of 14C-racemic warfarin to plasma from 25 normal male and 25 normal female subjects of similar age disclosed no sex differences either in the extent of binding of these drugs or in serum albumin concentration. The possibility of sex differences in rates of gastrointestinal absorption of other drug should be investigated.