TY - JOUR
T1 - The Corticotropin-Releasing Factor Stimulation Test
T2 - An Aid in the Evaluation of Patients with Cushing's Syndrome
AU - Chrousos, George P.
AU - Schulte, Heinrich M.
AU - Oldfield, Edward H.
AU - Gold, Philip W.
AU - Cutler, Gordon B.
AU - Loriaux, D. Lynn
PY - 1984/3/8
Y1 - 1984/3/8
N2 - We investigated the effect of exogenous corticotropin-releasing factor on plasma levels of ACTH and Cortisol in 13 patients with ACTH-secreting pituitary adenomas (Cushing's disease) and in 9 patients with other forms of Cushing's syndrome. In all patients with Cushing's disease, ovine corticotropin-releasing factor, given intravenously as a bolus injection (1 μg per kilogram of body weight), caused a further increase in the already elevated levels of ACTH and cortisol. Successful transsphenoidal adenomectomy was followed as early as one week after surgery by normalization or near-normalization of the ACTH and cortisol responses to corticotropin-releasing factor. On the other hand, patients with the ectopic ACTH syndrome, who also had high basal plasma concentrations of ACTH and cortisol, had no ACTH or cortisol responses to corticotropin-releasing factor. This difference in responsiveness between these two patient groups cannot be explained on the basis of different metabolic clearance rates of exogenous corticotropin-releasing factor, as shown by similar disappearance curves of immunoreactive corticotropin-releasing factor from plasma. Patients with Cushing's syndrome of adrenal origin who were hypercortisolemic during testing had undetectable plasma levels of ACTH and no ACTH or cortisol responses to corticotropin-releasing factor. We conclude that stimulation of the pituitary-adrenal axis with corticotropin-releasing factor may be useful in differentiating pituitary from ectopic causes of Cushing's syndrome. (N Engl J Med 1984; 310:622–6.).
AB - We investigated the effect of exogenous corticotropin-releasing factor on plasma levels of ACTH and Cortisol in 13 patients with ACTH-secreting pituitary adenomas (Cushing's disease) and in 9 patients with other forms of Cushing's syndrome. In all patients with Cushing's disease, ovine corticotropin-releasing factor, given intravenously as a bolus injection (1 μg per kilogram of body weight), caused a further increase in the already elevated levels of ACTH and cortisol. Successful transsphenoidal adenomectomy was followed as early as one week after surgery by normalization or near-normalization of the ACTH and cortisol responses to corticotropin-releasing factor. On the other hand, patients with the ectopic ACTH syndrome, who also had high basal plasma concentrations of ACTH and cortisol, had no ACTH or cortisol responses to corticotropin-releasing factor. This difference in responsiveness between these two patient groups cannot be explained on the basis of different metabolic clearance rates of exogenous corticotropin-releasing factor, as shown by similar disappearance curves of immunoreactive corticotropin-releasing factor from plasma. Patients with Cushing's syndrome of adrenal origin who were hypercortisolemic during testing had undetectable plasma levels of ACTH and no ACTH or cortisol responses to corticotropin-releasing factor. We conclude that stimulation of the pituitary-adrenal axis with corticotropin-releasing factor may be useful in differentiating pituitary from ectopic causes of Cushing's syndrome. (N Engl J Med 1984; 310:622–6.).
UR - http://www.scopus.com/inward/record.url?scp=0021326630&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0021326630&partnerID=8YFLogxK
U2 - 10.1056/NEJM198403083101004
DO - 10.1056/NEJM198403083101004
M3 - Article
C2 - 6319991
AN - SCOPUS:0021326630
SN - 0028-4793
VL - 310
SP - 622
EP - 626
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 10
ER -