Journal of Clinical Endocrinology & Metabolism, Vol 80, 2336-2341, Copyright © 1995 by Endocrine Society

ARTICLES

Lysine vasopressin stimulation of cortisol secretion in patients with adrenocorticotropin-independent macronodular adrenal hyperplasia

N Horiba, T Suda, M Aiba, M Naruse, K Nomura, M Imamura and H Demura
Department of Medicine, Tokyo Women's Medical College, Japan.

We present two patients with Cushing's syndrome due to ACTH-independent macronodular adrenal hyperplasia who showed marked plasma cortisol response to lysine-8-vasopressin (LVP) injection (from 930 and 731 pmol/L to 2177 and 1920 pmol/L, respectively), while plasma ACTH levels remained undetectable. The ACTH independence of cortisol secretion in the two patients was determined from the following endocrinological findings. Plasma cortisol levels were not increased by corticotropin- releasing hormone injections and were not suppressed by high dose (16 mg) dexamethasone administrations. The plasma ACTH levels, measured by two independent sensitive immunoassays, were persistently undetectable even after corticotropin-releasing hormone injection, metyrapone administration, and bilateral adrenalectomy. The particular pathological finding of the two cases, atrophic lesions in nonnodular parts of the adrenal cortexes, also indicated ACTH independence of the macronodular hyperplasia. In vitro examination revealed a direct effect of LVP on cortisol secretion from the adrenal cells of the macronodules. We also examined seven patients with Cushing's syndrome caused by adrenal adenoma and found a statistically significant plasma cortisol response to LVP injection. The direct effect of LVP was also demonstrated in cultured adenoma cells. In conclusion, we discovered a direct adrenal effect of LVP on cortisol secretion in patients with ACTH-independent macronodular hyperplasia and, to a lesser extent, in patients with cortisol-producing adrenal adenoma. The cortisol response to LVP may serve to facilitate their diagnosis and choice of therapy.

This article has been cited by other articles:

				V. Perraudin, C. Delarue, H. Lefebvre, J.-L. Do Rego, H. Vaudry, and J.-M. Kuhn Evidence for a Role of Vasopressin in the Control of Aldosterone Secretion in Primary Aldosteronism: in Vitro and in Vivo Studies J. Clin. Endocrinol. Metab., April 1, 2006; 91(4): 1566 - 1572. [Abstract] [Full Text] [PDF]

				A. Lacroix, N. N'Diaye, J. Tremblay, and P. Hamet Ectopic and Abnormal Hormone Receptors in Adrenal Cushing's Syndrome Endocr. Rev., February 1, 2001; 22(1): 75 - 110. [Abstract] [Full Text]

				H. Mircescu, J. Jilwan, N. N'Diaye, I. Bourdeau, J. Tremblay, P. Hamet, and A. Lacroix Are Ectopic or Abnormal Membrane Hormone Receptors Frequently Present in Adrenal Cushing's Syndrome? J. Clin. Endocrinol. Metab., October 1, 2000; 85(10): 3531 - 3536. [Abstract] [Full Text]

				J. L. Doppman, G. P. Chrousos, D. A. Papanicolaou, C. A. Stratakis, H. R. Alexander, and L. K. Nieman Adrenocorticotropin-independent Macronodular Adrenal Hyperplasia: An Uncommon Cause of Primary Adrenal Hypercortisolism Radiology, September 1, 2000; 216(3): 797 - 802. [Abstract] [Full Text]

				F. P. Pralong, F. Gomez, L. Guillou, F. Mosimann, S. Franscella, and R. C. Gaillard Food-Dependent Cushing's Syndrome: Possible Involvement of Leptin in Cortisol Hypersecretion J. Clin. Endocrinol. Metab., October 1, 1999; 84(10): 3817 - 3822. [Abstract] [Full Text] [PDF]

				E. Grazzini, C. Breton, S. Derick, M. Andres, D. Raufaste, F. Rickwaert, G. Boccara, P. Colson, N. C. Guérineau, C. Serradeil-Le Gal, et al. Vasopressin Receptors in Human Adrenal Medulla and Pheochromocytoma J. Clin. Endocrinol. Metab., June 1, 1999; 84(6): 2195 - 2203. [Abstract] [Full Text]

				N. N’Diaye, J. Tremblay, P. Hamet, W. W. De Herder, and A. Lacroix Adrenocortical Overexpression of Gastric Inhibitory Polypeptide Receptor Underlies Food-Dependent Cushing's Syndrome J. Clin. Endocrinol. Metab., August 1, 1998; 83(8): 2781 - 2785. [Abstract] [Full Text]

				G. Arnaldi, J.-M. Gasc, Y. de Keyzer, M.-L. Raffin-Sanson, V. Perraudin, J.-M. Kuhn, M.-C. Raux-Demay, J.-P. Luton, E. Clauser, and X. Bertagna Variable Expression of the V1 Vasopressin Receptor Modulates the Phenotypic Response of Steroid-Secreting Adrenocortical Tumors J. Clin. Endocrinol. Metab., June 1, 1998; 83(6): 2029 - 2035. [Abstract] [Full Text]

				A. Lacroix, J. Tremblay, G. Rousseau, M. Bouvier, and P. Hamet Propranolol Therapy for Ectopic {beta}-Adrenergic Receptors in Adrenal Cushing's Syndrome N. Engl. J. Med., November 13, 1997; 337(20): 1429 - 1434. [Full Text] [PDF]

				A. Lacroix, J. Tremblay, R. M. Touyz, L. Y. Deng, R. Lariviere, J. R. Cusson, E. L. Schiffrin, and P. Hamet Abnormal Adrenal and Vascular Responses to Vasopressin Mediated by a V1-Vasopressin Receptor in a Patient with Adrenocorticotropin-Independent Macronodular Adrenal Hyperplasia, Cushing's Syndrome, and Orthostatic Hypotension J. Clin. Endocrinol. Metab., August 1, 1997; 82(8): 2414 - 2422. [Abstract] [Full Text] [PDF]