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Plasma Levels of Corticotropin-Releasing Hormone in the Inferior Petrosal Sinuses of Healthy Volunteers, Patients with Cushing’s Syndrome, and Patients with Pseudo-Cushing States

Office of the Director (J.A.Y.) and the Department of Diagnostic Radiology (J.L.D.), Warren Grant Magnuson Clinical Center; the Developmental Endocrinology Branch, National Institute of Child Health and Human Development (J.A.Y., L.K.N., G.P.C.); the Clinical Neuroendocrinology Branch, National Institute of Mental Health (P.W.G., K.T.K.); and the Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (R.L.W.), National Institutes of Health, Bethesda, Maryland 20892; and the Department of Psychiatry and Human Behavior (K.T.K.), University of Mississippi Medical Center School of Medicine, Jackson, Mississippi 39216

Address all correspondence and requests for reprints to: Jack A. Yanovski, M.D., Ph.D., National Institutes of Health, 10 Center Drive, MSC 1862, Building 10, Room 10N262, 9000 Rockville Pike, Bethesda, Maryland 20892-1862. E-mail: jy15i{at}nih.gov

The objective of this study was to determine whether measurements of human CRH in the inferior petrosal sinuses could distinguish patients with Cushing’s syndrome from those with pseudo-Cushing states or normal physiology. Twenty-five patients with Cushing’s disease, 17 patients with the syndrome of ectopic ACTH, 7 patients with Cushing’s syndrome of adrenal origin, 6 patients with pseudo-Cushing states, and 11 volunteers believed to have normal hypothalamic-pituitary-adrenal axes were studied. Basal plasma human CRH and ACTH were measured at two time points in the petrosal sinuses and in a peripheral vein. Most subjects were studied after the administration of intravenous diazepam or midazolam and fentanyl, but because of the known inhibitory effects of such sedation on CRH secretion, 2 normal volunteers and 3 patients with pseudo-Cushing states were studied without sedation. Human CRH levels were near or below the detection limit of the assay in all subjects. Although the normal volunteers and patients with pseudo-Cushing states who were studied without sedation had significantly greater inferior petrosal sinus ACTH levels than those who received sedation, there were no differences in measured human CRH levels for any of the groups. We conclude that inferior petrosal sinus human CRH levels are not easily measured in the inferior petrosal sinuses and cannot be used to determine whether individual patients may have hypersecretion of CRH causing their ACTH secretion.