Familial Cushing's syndrome due to nodular adrenocortical dysplasia. A putative receptor-antibody disease?

Two sisters aged 13 and 19 years suffering from familial Cushing's syndrome due to nodular adrenocortical dysplasia are described. Pituitary adrenocortical function tests indicated the presence of adrenal autonomy. Adrenal scintigraphy showed bilateral symmetrical uptake indicating the bilateral character of the autonomous process. Complete adrenalectomy was performed in both girls. The adrenals were of about normal weight showing numerous dark brown pigmented nodules and small perivascular lymphocytic infiltrates. Serum immunoglobulin preparations obtained from both girls stimulated adrenocortical cell growth in a cytochemical bioassay system. It is proposed that circulating growth factors may be involved in the pathogenesis of the disease.

In vitro trophic effects of synthetic ACTH1-24.

In vitro trophic effects of adrenocorticotrophin1-24 (ACTH1-24, Synacthen) on adrenal cells were studied, using an in vitro assay system of guinea-pig adrenal segments kept in organ culture. Two separate methods for detecting growth activity were used, namely the measurement of thymidine kinase and a nucleic acid cytophotometric method. Synthetic ACTH was able to induce growth in the adrenal explants at very low concentrations (10-25 fg ml-1). Biphasic dose-response curves were obtained, comparable to those described for other cytochemical bioassays. The principles of this assay system may allow the development of a new bioassay for the measurement of plasma concentrations of ACTH or antibodies mimicking the growth effect of this trophic hormone.