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Sequential Cerebrospinal Fluid and Plasma Sampling in Humans: 24-Hour Melatonin Measurements in Normal Subjects and after Peripheral Sympathectomy

Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke (J.B., C.R., E.O.), and the Clinical Psychobiology Branch (L.T.), and the Laboratory of Clinical Sciences (S.M.), National Institute of Mental Health, National Institutes of Health Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Dr. Jeffrey Bruce, Department of Neurosurgery, Neurological Institute, Box 122, Columbia University College of Physicians and Surgeons, New York, New York 10032.

Simultaneous measurements of plasma and cerebrospinal fluid (CSF) melatonin and urinary excretion of 6-hydroxymelatonin were performed in four normal volunteers and one patient before and after upper thoracic sympathectomy for the control of essential hyperhidrosis. For normal individuals, hourly 24-h melatonin concentrations in plasma and CSF exhibited similar profiles, with low levels during the day and high levels at night. Peak plasma levels varied from 122–660 pmol/L, and the peak CSF levels from 94–355 pmol/L. The onset of the nocturnal increase in melatonin did not occur at the same time for each individual. Urinary 6-hydroxymelatonin levels also exhibited a daily rhythm, with peak excretion at night. The individual with the lowest nocturnal levels of circulating melatonin also had the lowest excretion of 6-hydroxymelatonin.

In the patient with hyperhidrosis, a prominent melatonin rhythm was observed preoperatively in the CSF and plasma. After bilateral T1-T2 ganglionectomy, however, melatonin levels were markedly reduced, and the diurnal rhythm was abolished. These results provide direct evidence in humans for a diurnal melatonin rhythm in CSF and plasma as well as regulation of this rhythm by sympathetic innervation. (J Clin Endocrinol Metab 72: 819–823, 1991)

^* Department of Neurosurgery, Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032.

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