DISTURBANCE OF THE PITUITARY-ADRENAL INTERRELATIONSHIP IN DISEASES OF THE CENTRAL NERVOUS SYSTEM*

Publisher Website
Google Scholar
Abstract
Of 14 patients with disorders of the hypothalamus or temporal lobes, 3 showed a disturbance of the reciprocal pituitary-adrenal interrelationship. These 3 patients failed to manifest evidence of increased pituitary ACTH secretion in response to lowered levels of plasma cor-tisol, as judged by the inability of the 11[beta] hydroxylase inhibitor, Su-4885, to elicit the expected increase in urinary 17-KGS excretion. In these 3 patients there was no radiologic evidence of pituitary disease; the baseline excretion of 17-KGS was normal, and the adrenal response to intravenous ACTH was normal. Two of the 3 patients were tested with large doses of dexamethasone and failed to show the expected fall in urinary 17-KGS or 17-KS. It appears probable that the basic neurologic disorder in these patients had disrupted the normal function of certain central nervous system centers sensitive to varying levels of circulating glucocorticoids and controlling the modulation of pituitary ACTH secretion. One patient unresponsive to both Su-4885 and dexamethasone reacted to the intravenous injection of bacterial pyrogen with a prompt rise in the level of plasma 17-OH-CS and urinary excretion of 17-KGS and 17-KS. Moreover, the normal diurnal variation in plasma 17-OH-CS was found in the 2 patients who were unresponsive to Su-4885. It is thus possible that the mechanisms leading to the normal diurnal variation of plasma 17-OH-CS and to the normal adrenal response to stressful stimuli do not involve those centers postulated to control the reciprocal pituitary-adrenal interrelationship.