Effect of bromocriptine in pituitary-dependent Cushing's syndrome.

To assess the therapeutic value of a dopaminergic drug on abnormal ACTH secretion, we studied the effect of bromocriptine during short and long-term treatment in nine patients with active pituitary-dependent Cushing's syndrome. The single oral dose effect of bromocriptine (2.5 mg at 0800 h) on ACTH samples obtained every half hour for 3 h, was studied in six patients with Cushing's disease; in no case was suppression of ACTH observed. In five patients, the effect of bromocriptine was also investigated after its administration for two consecutive days (5 mg/d) with plasma samples taken every half hour for 12 h; in three cases no suppression of plasma ACTH was observed, while the other two showed a significant decrease. Three of our patients (a nonresponder to the single dose, a responder to the two-day treatment, and an untested patient) were subjected to prolonged bromocriptine administration (2-45 months). In the first two patients only, biochemical data and clinical symptoms showed improvement, while the other patient showed only initial benefit. These data show that bromocriptine may occasionally reduce ACTH secretion in pituitary-dependent Cushing's syndrome, and that a single oral dose bromocriptine test fails to identify the patients who will benefit from this treatment.

Stimulation tests in adreno-genital syndrome induced by 21 hydroxylase deficit.

GnRH and TRH stimulation were performed on 4 patients affected by 21-beta-hydroxylase adrenal deficit. Plasmatic FSH, LH, 17-beta-estradiol, HPRL were assayed before and after GnRH, and HPRL before and after TRH. The results seem to prove that these tests are useless for the diagnosis of adrenal enzymatic deficit. On the other hand, they provide interesting additional information on physiopathological relations between adrenals and gonadotropins and between HPRL and adrenals.

Deficit of 21 beta-hydroxylase. Clinico-functional parameters.

The authors report the hormonal pictures of 5 young women with partial deficit of 21-beta-hydroxylase. They performed 17OH-progesterone, DHEA-S, plasma cortisol, free urinary cortisol, testosterone, ACTH and urinary 17KS assays. They then performed a suppression test by Desametazone and stimulus test by ACTH. The Authors stress the major role of 17OH progesterone, assayed in basal conditions and after ACTH stimulus, recalling the importance of early diagnosis. Authors also stress that in these patients testosterone is always significantly high.

Hyperprolactinemia and pregnancy. Clinical series.

We report 15 cases of pregnancy in 11 patients with hyperprolactinemia. These patients initially went to our Gynecologic Endocrinology Center for various menstrual troubles. They were all treated with bromocriptine, except one whose hyperprolactinemia was diagnosed when she had already started a gonadotropin therapy, since HPRL assays performed elsewhere had given normal results. In 6 patients we diagnosed prolactin-secreting pituitary adenoma. Only two patients underwent adenomectomy. All patients gave up bromocryptine as soon as their pregnancy was detected. Two patients had two subsequent pregnancies, another one had three. All pregnancies were single. The only twin pregnancy followed a gonadotropin therapy. One of the 15 pregnancies ended with abortion at the 12th week; another one (twin) with spontaneous delivery at the 37th week; 13 with term-delivery. They all had physiologic courses, except for one case of threatened abortion and one case of diabetes insipidus at the 9th month. None of the 15 newborns (7 SGA and 8 AGA) showed malformations. No sign or symptom of tumour growth was detected in the patients affected by pituitary adenoma.

Circadian secretion of ACTH, cortisol, and mineralocorticoids in Cushing's syndrome.

The behaviour of plasma levels of ACTH was studied in five untreated patients with pituitary-dependent Cushing's syndrome, with blood samples taken every half an hour for a total period of 24 hours; plasma cortisol, corticosterone, deoxycorticosterone (DOC) and aldosterone were also measured simultaneously. In all cases, above normal secretory impulses of ACTH and cortisol, at approximately the same height, were present throughout the day, while between these peaks the levels were in the normal range. Few peaks of ACTH and cortisol were simultaneous and rare secretory impulses of corticosterone, and deoxycorticosterone were in synchrony with those of ACTH or cortisol. DOC levels were found to have some peaks above normal levels while corticosterone levels presented rare elevated peaks during the day. Plasma aldosterone values on the other hand, were extremely low in all except in one case, where the variations may be interpreted as pure fluctuations. These findings confirm that: 1) In a number of cases, multiple samples of ACTH and cortisol (during the 24 hrs.) appear to be essential in order to distinguish pituitary-dependent Cushing's syndrome from normal; 2) In conditions of ACTH excess, DOC and corticosterone secretion seems to become progressively less ACTH-dependent as we proceed down the biosynthetic chain towards aldosterone, which is suppressed in most cases.

"Euthyroidal' goiter and menstrual disorders.

We selected 5 patients, between 18 and 31 years of age, presenting menstrual irregularities and thyroidal goiter with no apparent functional change (normal, T4 and T3 tests). These patients underwent further examinations: TSH (basal and after TRH stimulation), HPRL (basal-circadian rhythm and after TRH stimulation), FSH and LH (basal and after Gn-RH stimulation), thyroidal scintiscan, search for antithyroid antibodies. Basal and post-stimulation TSH was fundamental in 2 cases of subclinical hypothyroidism. The positive antibody search confirmed the antoimmune origin. In the same patients, the HPRL circadian rhythm and TRH test highlighted a secondary hyperprolactinemia which would not have been revealed by a single basal sample.