title: ACTH response to desmopressin in a patient with acromegaly; expression of corticotropin-releasing factor, urocortins and vasopressin V1b receptor in GH-producing pituitary adenoma.
abstract: GH-producing pituitary adenomas frequently co-produce other certain anterior pituitary hormones, such as prolactin (PRL). In contrast, GH-producing adenomas which express all of corticotropin-releasing factor (CRF), urocorin1 (Ucn1) and urocortin3 (Ucn3) have not been reported. A 39-year-old woman was admitted for evaluation of the pituitary tumor. The diagnosis of acromegaly was confirmed by elevated serum GH and IGF-I levels, and the absence of GH suppression by oral glucose tolerance test. ACTH response to desmopressin (DDAVP) was observed (plasma ACTH levels increased from 13.9 to 50.4 pg/ml at 90 min). Although it is known that ACTH response to DDAVP is considerably useful for the diagnosis of ACTH-dependent Cushing's syndrome, the diagnosis of Cushing's disease was not supported by the criteria. The patient underwent transsphenoidal resection of the pituitary tumor. Immunohistological examination confirmed a GH- and PRL-producing adenoma, whereas ACTH was negative. ACTH response to DDAVP disappeared after tumor removal. To determine the cause of preoperative ACTH response to DDAVP, we examined expression of CRF family peptides and vasopressin V1b receptor in the pituitary adenoma by immunohistochemistry. Immunohistochemistry revealed positive immunostaining for CRF, Ucn1, Ucn3 and vasopressin V1b receptor in the adenoma. These observations raised the possibility that DDAVP caused an ACTH response, perhaps via the paracrine effects of tumor-derived CRF and Ucn1. When ACTH response to DDAVP is observed in patients with pituitary tumor, not only the direct effect of DDAVP on ACTH secretion, but also a possible involvement of CRF and/or urocortins expressed in the pituitary adenoma, should be considered.
authors: Department of Endocrinology and Metabolism, Suifu Hospital, Mito 311-4141, Japan. arihara-zen@umin.ac.jp
authors: Zenei
authors: Z
authors: Arihara
authors: Kanako
authors: K
authors: Sakurai
authors: Yoshinori
authors: Y
authors: Osaki
authors: Hiroshi
authors: H
authors: Fukazawa
authors: Shozo
authors: S
authors: Yamada
authors: Naoko
authors: N
authors: Inoshita
authors: Osamu
authors: O
authors: Murakami
authors: Koji
authors: K
authors: Ohba
authors: Kazuhiro
authors: K
authors: Takahashi
mesh_terms: D000172:Acromegaly / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D000236:Adenoma / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D003346:Corticotropin-Releasing Hormone / Q000096:biosynthesis*; D003480:Cushing Syndrome / Q000175:diagnosis; D003894:Deamino Arginine Vasopressin; D003937:Diagnosis, Differential; D005260:Female; D019382:Human Growth Hormone / Q000096:biosynthesis; D006801:Humans; D007150:Immunohistochemistry; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery; D017483:Receptors, Vasopressin / Q000096:biosynthesis*; D054832:Urocortins / Q000096:biosynthesis*
chemical_list: D017483:Receptors, Vasopressin; D054832:Urocortins; D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D003894:Deamino Arginine Vasopressin