The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone.

BACKGROUND: Suppression of pituitary-adrenal function is a well-known consequence of glucocorticoid therapy, manifested principally by decreased corticotropin secretion. To determine the degree of suppression of pituitary-adrenal function in patients treated with different doses of synthetic glucocorticoid medication for different periods, we measured the pituitary-adrenal response to the administration of exogenous human corticotropin-releasing hormone (CRH). METHODS: We studied 279 patients who were receiving daily therapy with 5 to 30 mg of prednisone or its equivalent to treat various chronic diseases, principally collagen vascular disorders, and 50 normal subjects. Therapy ranged in duration from 1 week to 15 years. Stimulation tests using 100 micrograms of CRH as a bolus injection were performed in the morning, 24 hours after the most recent dose of glucocorticoids. In 61 patients an insulin hypoglycemia test, thought by many to be the reference standard, was also performed to assess the reliability of the CRH results. RESULTS: After the administration of CRH, 43 patients had no increase in plasma concentrations of corticotropin and cortisol. The response was blunted in 133 patients and normal in 103. There was poor correlation between the plasma cortisol response after the administration of CRH and the dose or duration of therapy or the basal plasma cortisol concentration. Although plasma cortisol concentrations after stimulation with CRH were generally lower than those after insulin administration, there was a significant correlation between the plasma cortisol responses to the two stimuli (r = 0.82). CONCLUSIONS: Pituitary-adrenal function in patients treated with synthetic glucocorticoids cannot be reliably estimated from the dose of glucocorticoid, the duration of therapy, or the basal plasma cortisol concentration. In such patients, testing with CRH is nearly as useful as insulin hypoglycemia testing in the assessment of pituitary-adrenal function.

[Pseudohypoparathyroidism and adrenal cortex insufficiency. A case of multiple endocrinopathy due to peripheral hormone resistance]. / Pseudohypoparathyreoidismus und Nebennierenrindeninsuffizienz. Ein Fall von Multipler Endokrinopathie bei peripherer Hormonresistenz.

Since his childhood a now 31-year-old male showed typical symptoms of parathyroid hormone deficiency with hypocalcemia and hyperphosphatemia. We found a target organ resistance to parathyroid hormone and diagnosed pseudohypoparathyroidism. In addition adrenal insufficiency with hypocortisolism was seen. Both hormone systems act by stimulating adenylate cyclase. A defective receptor-adenylate cyclase complex may cause this--for the first time described--combination of endocrine insufficiency.

[Corticotropin-releasing hormone (CRH) test for monitoring glucocorticoid therapy]. / Corticotropin-Releasing-Hormon(CRH)-Test bei der Uberwachung der Glucocorticoidtherapie.

Suppression of endogenous cortisol production was assessed by a corticotropin-releasing hormone (CRH) test 24 hours after the last dose of the glucocorticoid in 48 patients (27 women and 21 men; mean age 48.9 [21-69] years) who had been taking fluocortolone for inflammatory rheumatic disease. Both during a few weeks of treatment (9 patients) and after a year (39 patients) complete suppression of endogenous cortisol production occurred in 17 patients, partial suppression in 17. This suppression did not unequivocally correlate with the dosage or duration of treatment, but there was a tendency towards it at higher dose levels (15-30 mg). Cortisol response to the CRH test was unremarkable in 14 patients. These results suggest that secondary adrenal insufficiency is to a considerable extent dependent on individual factors. Correspondingly the degree of suppression of the adrenal axis cannot be predicted for an individual patient without suitable testing.

Micromethod for colony growth of erythroid and granulocytic cell colonies in glass capillaries.

Mononuclear cells of peripheral blood were cultured in glass capillary tubes under various conditions. The highest number of granulopoietic colonies was found with 5 X 10(4) cells per capillary and 10% conditioned medium. The growth of erythroid colonies did not depend on erythropoietin linearly, but a good correlation was found between the number of cells and the erythropoietin concentration respectively when the single erythroid precursor cells were counted on the slides. The highest yield of erythroid cells was noted at 0.5 U erythropoietin at all cell concentrations.