Nyctohemeral variation and suppressibility of plasma ACTH in various stages of Cushing's disease

D. M. Cook, John Kendall, J. P. Allen, L. G. Lagerquist

Research output: Contribution to journalArticle

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Abstract

In order to define nyctohemeral plasma ACTH secretory patterns, frequent plasma ACTH samples were obtained in seven patients with untreated Cushing's disease (i.e. pituitary dependent Cushing's syndrome), five Cushing's patients treated by bilateral adrenalectomy, four of whom had Nelson's syndrome, and one patient with 21 hydroxylase deficiency (congenital adrenal hyperplasia). A nyctohemeral rhythm of plasma ACTH concentration was apparent in the one patient with the adrenogenital syndrome but not in those with Nelson's syndrome or Cushing's disease. The effect of graded doses of dexamethasone, 2, 8 or 32 mg per 24 h period, on plasma ACTH concentrations was studied in patients with untreated or treated Cushing's disease or Nelson's syndrome. In all of these hypercorticotrophic states, the mean plasma ACTH concentration was not significantly affected by the smallest dose of dexamethasone, was partially suppressed by the intermediate dose, and further suppressed by the largest dose. In contrast, the patient with congenital adrenal hyperplasia and elevated plasma ACTH concentrations showed complete suppression of plasma ACTH levels following the smallest dose of dexamethasone. These findings indicate that there is resistance to ACTH suppression by dexamethasone in all stages of Cushing's disease and suggest that negative feedback of glucocorticoids may be involved in the pathogenesis of this disease.

Original languageEnglish (US)
Pages (from-to)303-312
Number of pages10
JournalClinical Endocrinology
Volume5
Issue number4
StatePublished - 1976

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Pituitary ACTH Hypersecretion
Adrenocorticotropic Hormone
Nelson Syndrome
Dexamethasone
Congenital Adrenal Hyperplasia
Adrenogenital Syndrome
Cushing Syndrome
Adrenalectomy
Circadian Rhythm
Glucocorticoids

ASJC Scopus subject areas

  • Endocrinology

Cite this

Cook, D. M., Kendall, J., Allen, J. P., & Lagerquist, L. G. (1976). Nyctohemeral variation and suppressibility of plasma ACTH in various stages of Cushing's disease. Clinical Endocrinology, 5(4), 303-312.

Nyctohemeral variation and suppressibility of plasma ACTH in various stages of Cushing's disease. / Cook, D. M.; Kendall, John; Allen, J. P.; Lagerquist, L. G.

In: Clinical Endocrinology, Vol. 5, No. 4, 1976, p. 303-312.

Research output: Contribution to journalArticle

Cook, DM, Kendall, J, Allen, JP & Lagerquist, LG 1976, 'Nyctohemeral variation and suppressibility of plasma ACTH in various stages of Cushing's disease', Clinical Endocrinology, vol. 5, no. 4, pp. 303-312.
Cook, D. M. ; Kendall, John ; Allen, J. P. ; Lagerquist, L. G. / Nyctohemeral variation and suppressibility of plasma ACTH in various stages of Cushing's disease. In: Clinical Endocrinology. 1976 ; Vol. 5, No. 4. pp. 303-312.
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