The insulin tolerance test and the ovine corticotrophin-releasing hormone test in episodic cluster headache.
Clinical observations indicate a central nervous system, probably hypothalamic, involvement in cluster headache pathogenesis. In order to investigate the supposed hypothalamic involvement in cluster headache, we followed the hypothalamic-pituitary-adrenal axis and autonomic responses to the insulin tolerance test and the ovine corticotrophin-releasing hormone test in episodic cluster headache patients, both during remission and during the cluster period. The study revealed increased basal cortisol levels in all cluster patients. A blunted cortisol response to ovine corticotrophin-releasing hormone, in spite of a normal ACTH surge, was subsequently found in both illness phases. These findings suggest hypothalamic-pituitary-adrenal axis hyperactivity in both cluster phases. Furthermore, reduced ACTH and cortisol responses after insulin challenge were also observed in both remission and cluster period patients; a reduced norepinephrine surge was seen only in the cluster period. Taken together, these results suggest a hypothalamic involvement in the altered neuroendocrinological and autonomic responses found in our patients.
Leone
M
M
Headache Centre, Istituto Neurologico C. Besta, Milan, Italy.
Zappacosta
B M
BM
Valentini
S
S
Colangelo
A M
AM
Bussone
G
G
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000704:Analysis of Variance; D001786:Blood Glucose / Q000187:drug effects; D003027:Cluster Headache / Q000097:blood* / Q000503:physiopathology; D003346:Corticotropin-Releasing Hormone; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007328:Insulin; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D013997:Time Factors
D001786:Blood Glucose; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone; D009638:Norepinephrine