Journal of Clinical Endocrinology & Metabolism, Vol 79, 390-394, Copyright © 1994 by Endocrine Society

ARTICLES

The combined corticotropin-releasing hormone/lysine vasopressin test discloses a corticotroph phenotype

X Bertagna, J Coste, MC Raux-Demay, M Letrait and G Strauch
Clinique des Maladies Endocriniennes et Metaboliques, ECLIMED Institut de Recherche Therapeutique, Centre Hospitalier Universitaire, Cochin Universite Rene Descartes, Paris, France.

The combined administration of CRH and vasopressin to man now offers a powerful means to directly assess the pituitary corticotroph reserve. A double blind, randomized, placebo-controlled, cross-over trial offered the opportunity to perform the combined CRH/lysine vasopressin (LVP) test (100 micrograms ovine CRH, followed by 1 IU LVP over 15 min) on 3 different occasions without treatment in 10 normal male subjects. We showed that peak ACTH plasma levels after stimulation had wide intersubject variation, whereas they were remarkably stable in a given individual, with a mean intraclass correlation coefficient of 0.90 (95% confidence limits, 0.74-0.96). Peak ACTH plasma levels after CRH/LVP administration were not significantly correlated with basal plasma cortisol levels (r = -0.14; P > 0.45), but were strongly and inversely correlated with peak cortisol plasma levels after Cortrosyn stimulation (0.25 mg, im; r = -0.78; P < 0.0001). These data provide the first evidence that the overall hypothalamic-pituitary-adrenocortical axis has an intrinsic activity that is constitutively fixed for a given individual. The power of the combined CRH/LVP test offers a unique means to measure a genuine corticotroph phenotype in each individual.

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