A syndrome of periodic adrenocorticotropin and vasopressin discharge.
An 8-yr-old girl is presented who had periodic attacks of vomiting, psychotic depression, drowsiness, and hypertension (160/110 mm Hg) for a period of 16 months after head injury. At the initiation of the attack, serum ACTH and vasopressin levels were prominently increased (610 pg/ml and 41 microunits/ml, respectively), followed by hypercortisolemia, hyponatremia, and hypoosmolality in plasma. Serum PRL also was elevated (91 ng/ml). Responses of GH and cortisol to insulin-induced hypoglycemia and those of TSH to TRH were reduced. Urinary excretion of epinephrine and norepinephrine were increased, while dopamine (DA) excretion was reciprocally decreased, resulting in a marked elevation of the epinephrine plus norepinephrine to DA ratio during the episodes (0.4-4.5); this was normalized on attack-free days (0.08-0.25). During the attack, the concentration of homovanillic acid, a major metabolite of DA in the brain, also was reduced in cerebrospinal fluids from 70 to 23 ng/ml. The administration of methyl-dopa and reserpine effectively suppressed the recurrence of the episode. Although the exact cause of this syndrome is unknown, a periodic metabolic dysfunction of catecholamine in the central nervous system might be postulated.
D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D001924:Brain Concussion / Q000150:complications*; D002395:Catecholamines / Q000652:urine; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007328:Insulin; D008750:Methyldopa / Q000627:therapeutic use; D010507:Periodicity; D010908:Pituitary Hormones, Anterior / Q000097:blood; D011388:Prolactin / Q000097:blood; D012110:Reserpine / Q000627:therapeutic use; D013577:Syndrome; D013972:Thyrotropin; D013973:Thyrotropin-Releasing Hormone; D014667:Vasopressins / Q000378:metabolism*; D014839:Vomiting / Q000209:etiology
D002395:Catecholamines; D007328:Insulin; D010908:Pituitary Hormones, Anterior; D014667:Vasopressins; D008750:Methyldopa; D013973:Thyrotropin-Releasing Hormone; D012110:Reserpine; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D013972:Thyrotropin