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Persistence of a circadian rhythmicity of glucocorticoid secretion in a patient with Cushing’s syndrome: study before and after unilateral adrenalectomy

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Abstract

A 47-year-old woman affected by Cushing’s syndrome due to an adrenal adenoma is described. An altered but rhythmometrically apparent Cortisol secretory rhythm was detected using the single-cosinor computation. In fact serum Cortisol levels and urinary excretion of 17-OHCS were elevated in the PM hours, particularly between 14:00–18.00 h and 18:00–22:00 h, and normal between 02:00–10:00 h. The patient was cured by unilateral adrenalectomy and one year later the circadian rhythm of corticosteroids secretion was investigated again. A normal rhythm of Cortisol secretion and of 17-OHCS urinary excretion was found. Though it may be hypothesized that factors intrinsic to the tumoral adrenal cells were responsible for the rhythmic, but phase-shifted, hormonal release, the cause of the persistent and abnormal Cortisol secretory rhythm is unknown.

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References

  1. Ekman H., Hakansson B., McCarthy J.D., Lehmann J., Siögren B. Plasma 17-hydroxycorticosteroids in Cushing’s syndrome. J. Clin. Endocrinol. Metab. 21: 684, 1961.

    Article  CAS  PubMed  Google Scholar 

  2. Hellman L., Weitzman E.D., Roffwarg H., Fukushima D.K., Yoshida K., Gallagher T.F. Cortisol is secreted episodically in Cushing’s syndrome. J. Clin. Endocrinol. Metab. 30: 686, 1970.

    Article  CAS  PubMed  Google Scholar 

  3. Vetter H., Strass R., Bayer J.M., Beckerhoff R., Armbruster H., Vetter W. Short-term fluctuations in plasma Cortisol in Cushing’s syndrome. Clin. Endocrinol. (Oxf.) 6: 1, 1977.

    Article  CAS  Google Scholar 

  4. Jordan R.M., Ramos-Gabatin A., Kendall J.W., Gaudette D., Walls R.C. Dynamics of adrenocorticotropin (ACTH) secretion in cyclic Cushing’s syndrome: evidence for more than one abnormal ACTH biorhythm. J. Clin. Endocrinol. Metab. 55: 531, 1982.

    Article  CAS  PubMed  Google Scholar 

  5. Tourniaire J., Orgiazzi J., Riviere J.F., Rousset H. Repeated plasma Cortisol determinations in Cushing’s syndrome due to adrenocortical adenoma. J. Clin. Endocrinol. Metab. 32: 666, 1871.

    Article  Google Scholar 

  6. Sederberg-Olsen P., Binder C, Kehlet H., Neville A.M., Nielsen L.M. Episodic variation in plasma corticosteroids in subjects with Cushing’s syndrome of differing etiology. J. Clin. Endocrinol. Metab. 36: 906, 1973.

    Article  CAS  PubMed  Google Scholar 

  7. Olsen N.J., Fang V.S., De Groot L.J. Cushing’s syndrome due to adrenal adenoma with persistent diurnal Cortisol secretory rhythm. Metabolism 27: 695, 1978.

    Article  CAS  PubMed  Google Scholar 

  8. Silber R.H., Porter C.C. The determination of 17,21 dihydroxy-20-ketosteroids in urine and plasma. J. Biol. Chem. 210: 923, 1954.

    CAS  PubMed  Google Scholar 

  9. Drekter I.J., Heisler A., Schims G.R., Starn S., McGavack T.H. The determination of urinary steroids. I. The preparation of pigment-free extracts and a simplified procedure for the estimation of total 17-ketosteroids. J. Clin. Endocrinol. Metab. 12: 55, 1952.

    Article  CAS  PubMed  Google Scholar 

  10. Liberman B., Wajchenberg B.L., Tambascia M.A., Mesquita C.H. Periodic remission in Cushing’s disease with paradoxical dexamethasone response: an expression of periodic hormogenesis. J. Clin. Endocrinol. Metab. 43: 913, 1976.

    Article  CAS  PubMed  Google Scholar 

  11. Bailey R.E. Periodic hormogenesis. A new phenomenon. Periodicity in function of a hormone-pituitary tumor in man. J. Clin. Endocrinol. Metab. 32: 317, 1971.

    Article  CAS  PubMed  Google Scholar 

  12. Shiotsuka R., Jovonovich J., Jovonovich J.A. Circadian and ultradian corticosterone rhythms in adrenal organ cultures. In: Schattauer F.K. (Ed.), Chronobiological aspects of endocrinology. Springer Verlag, Stuttgart, 1974, p. 255.

    Google Scholar 

  13. Meier A.M. Daily variation in concentration of plasma corticosteroid in hypophysectomized rats. Endocrinology 98: 1475, 1976.

    Article  CAS  PubMed  Google Scholar 

  14. Ungar F., Halberg F. Circadian rhythm in the in vitro response of mouse adrenal to adrenocorticotropic hormones. Science 137: 1058, 1962.

    Article  CAS  PubMed  Google Scholar 

  15. Macchi I.A., Scotch D.S. In vitro effects of acetylcholine on adrenocortical secretion of incubated rat adrenals. Proc. Soc. Exp. Biol. Med. 106: 324, 1961.

    Article  CAS  PubMed  Google Scholar 

  16. Sayers G., Ma R.M., Giordano N.D. Isolated adrenal cells: corticosterone production in response to cyclic AMP (adenosine-3′, 5′-monophosphate). Proc. Soc. Exp. Biol. Med. 136: 619, 1971.

    Article  CAS  PubMed  Google Scholar 

  17. Saruta T., Kaplan N.M. Adrenocortical steroidogenesis: the effects of prostaglandins. J.Clin. Invest. 57: 2246, 1972.

    Article  Google Scholar 

  18. Sharma R.K., Ahmed N.K., Shanker G. Metabolic regulation of steroidogenesis in isolated adrenal cells of rat. Eur. J. Biochem. 70: 427, 1976.

    Article  CAS  PubMed  Google Scholar 

  19. Seiden G., Brodish A. Persistence of a diurnal rhythm in hypothalamic corticotropin-releasing factor (CRF) in the absence of hormone feed-back. Endocrinology 30: 1401, 1972.

    Article  Google Scholar 

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Ambrosi, B., Riva, E. & Faglia, G. Persistence of a circadian rhythmicity of glucocorticoid secretion in a patient with Cushing’s syndrome: study before and after unilateral adrenalectomy. J Endocrinol Invest 8, 363–367 (1985). https://doi.org/10.1007/BF03348515

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  • DOI: https://doi.org/10.1007/BF03348515

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