Recovery of hypothalamic-pituitary-adrenal function after long term suppression by aminoglutethimide and hydrocortisone

T. J. Worgul, John Kendall, R. J. Santen

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Little data are available concerning recovery of adrenal function after prolonged inhibition of steroidogenesis by enzyme inhibitors. Aminoglutethimide (AG), a potent blocker of adrenal steroid biosynthesis, combined with physiological replacement doses of hydrocortisone (HC) is currently being used to treate women with metastatic breast carcinoma. We studied the time-course of recovery of hypothalamic-pituitary-adrenal function after prolonged drug therapy in 10 women. Fifteen hours after stopping AG-HC therapy, 0900 h serum cortisol levels were normal [12.9 ± 3.4 (SEM) μg/100 ml], but increments observed after provocative stimulation were blunted. However, the cortisol responses to both insulin-induced hypoglycemia and Cortrosyn stimulation normalized 36 and 42 h after stopping AG and HC therapy. In addition, the concentration of plasma ACTH peaked at 175 ± 9.3 pg/ml 15 min after the nadir of hypoglycemia. Adrenal histology in two patients who died while on chronic AG and HC therapy showed hypertrophic cells with large amounts of finely vacuolated cytoplasm in the zona fasciculata but no other abnormalities. We conclude that recovery of the hypothalamic-pituitary-adrenal axis is complete within 36 h after discontinuing chronic AG and HC therapy. This is in contrast to the prolonged suppression observed after chronic therapy with pharmacological doses of glucocorticoids.

Original languageEnglish (US)
Pages (from-to)879-882
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume53
Issue number4
StatePublished - 1981
Externally publishedYes

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Aminoglutethimide
Hydrocortisone
Recovery
Hypoglycemia
Zona Fasciculata
Cosyntropin
Drug therapy
Therapeutics
Histology
Biosynthesis
Recovery of Function
Enzyme Inhibitors
Adrenocorticotropic Hormone
Glucocorticoids
Cytoplasm
Steroids
Pharmacology
Insulin
Breast Neoplasms
Plasmas

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Recovery of hypothalamic-pituitary-adrenal function after long term suppression by aminoglutethimide and hydrocortisone. / Worgul, T. J.; Kendall, John; Santen, R. J.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 53, No. 4, 1981, p. 879-882.

Research output: Contribution to journalArticle

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