scholarly journals Central ghrelin production does not substantially contribute to systemic ghrelin concentrations: a study in two subjects with active acromegaly

2002 ◽  
pp. 195-199 ◽  
Author(s):  
FM van der Toorn ◽  
JA Janssen ◽  
WW de Herder ◽  
F Broglio ◽  
E Ghigo ◽  
...  
Keyword(s):  
Significant Rise ◽  
Inferior Petrosal Sinus ◽  
Normal Range ◽  
Systemic Blood ◽  
Blood Samples ◽  
Inferior Petrosal Sinus Sampling ◽  
Petrosal Vein ◽  
Obese Subjects ◽  
Active Acromegaly ◽  
The Right

INTRODUCTION: In an animal model of acromegaly (PEPCK-hGH transgenic mice), low systemic levels of ghrelin have been observed compared with normal mice. We hypothesized that systemic circulating ghrelin levels are also decreased in humans with active acromegaly and that the contribution of central ghrelin production to systemic ghrelin levels is minimal. OBJECTIVES: The aim of the present study was to investigate, in two subjects with active acromegaly, whether there are differences between systemic ghrelin levels and ghrelin concentrations in the petrosal sinus. DESIGN: We measured systemic and central ghrelin levels in these two acromegalic patients by bilateral simultaneous inferior petrosal sinus sampling. Central and systemic blood samples were drawn before and 1, 5, 10, 15 and 20 min after stimulation with GH-releasing hormone (GHRH). Ghrelin was measured with a commercially available radioimmunoassay. RESULTS: In one acromegalic subject, the baseline systemic and central ghrelin levels were within the same range as in two non-acromegalic obese subjects. No gradient could be observed between central and systemic ghrelin concentrations. Stimulation with GHRH did not change the ghrelin concentrations in this patient. In the other acromegalic subject, the systemic ghrelin levels were also in the same range as in two non-acromegalic obese subjects. However, in this subject, baseline ghrelin concentrations in the right inferior petrosal vein were considerably lower than the systemic ghrelin concentrations, indicating a peripheral over central gradient. Administration of GHRH induced a significant rise in central ghrelin concentrations in the right inferior petrosal vein. Ghrelin levels in the left inferior petrosal vein and systemic ghrelin levels were in the normal range and GHRH stimulation did not change these concentrations. CONCLUSIONS: The absence of a central over peripheral ghrelin gradient in these two acromegalics indicated that circulating ghrelin is mainly produced peripherally. Circulating systemic ghrelin levels were not decreased in these two subjects with active acromegaly.

scholarly journals A pitfall of bilateral inferior petrosal sinus sampling in cyclic Cushing’s syndrome

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Adriana Albani ◽  
Christina M. Berr ◽  
Felix Beuschlein ◽  
Marcus Treitl ◽  
Klaus Hallfeldt ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Clinical Care ◽  
Cushing's Syndrome ◽  
Maximum Plasma ◽  
Positive Staining ◽  
Inferior Petrosal Sinus ◽  
Normal Range ◽  
Who Grade ◽  
Inferior Petrosal Sinus Sampling ◽  
Free Cortisol

Abstract Background Clinical care of patients with cyclic Cushing’s syndrome (CS) is challenging. Classical pitfalls include incorrect subtyping, unnecessary surgical procedures and delayed definite treatment. Case presentation A 43-year-old female suffered from a rapidly cycling ectopic CS. She experienced six cycles of severe hypercortisolism within a 2 year period (maximum plasma cortisol 5316 nmol/L, normal range 124.2–662.4 nmol/L; maximum urinary free cortisol 79,469 nmol/24 h, normal range < 414 nmol/24 h) lasting 2–9 weeks. The episodes were associated with pronounced hypokalemia (lowest K+ value recorded 2.4 mmol/l) and progressive signs and symptoms of CS. A bilateral inferior petrosal sinus sampling (BIPSS) performed during a trough phase was false positive for pituitary ACTH overproduction resulting in unnecessary transsphenoidal surgery while a second BIPSS performed during an active phase was indicative for ectopic CS. The 18F-DOPA PET/CT showed a pancreatic lesion, which was subsequently partially removed. Surprisingly, the histopathology was conclusive for ACTH-positive lymph node metastasis located in the retro-duodenal tissue of an occult neuroendocrine tumor WHO grade II. The primary tumor has not been identified so far and, because of the persistent hypercortisolism, the patient underwent bilateral adrenalectomy. Two years later, ACTH levels started to increase progressively. Percutaneous biopsy of a newly identified suspected lesion in the fifth thoracic vertebra revealed a metastasis with positive staining for ACTH, synaptophysin and chromogranin A. Therapy with carboplatin and etoposide was started and, since then, the patient underwent 12 cycles of chemotherapy. Conclusions We report the challenging case of a rapidly cycling CS secondary to ACTH-secreting neuroendocrine intestinal tumor of unknown primary. We highlight the importance of performing diagnostic tests only during the phases of active cortisol secretion and as soon as first symptoms appear to avoid pitfalls.

Influence of Certain Drugs on the Adhesiveness of Human, Rat, and Rabbit Blood Platelets in Vitro

1965 ◽  
Vol 13 (02) ◽  
pp. 428-438 ◽  
Author(s):  
K Reber ◽  
A Studer
Keyword(s):  
Sodium Citrate ◽  
Blood Platelets ◽  
Drug Application ◽  
Normal Range ◽  
Blood Samples ◽  
Serotonin Antagonist ◽  
Thrombocyte Count ◽  
Particle Count ◽  
Rabbit Blood

SummaryThis is a comparative study of the methods described by H. P. Wright and O’Brien for determining the adhesiveness of thrombocytes. An attempt is made to characterize and statistically correlate both techniques. With the aid of a Coulter Counter for thrombocyte counts, a normal range is presented for human, rat, and rabbit blood. Anticoagulants used are sodium citrate and Heparin.The influence of Cocaine and the Serotonin antagonist Ro 3-0837 was studied on these same substrates, to determine a pharmacological interference with results of either Wright’s test or O’Brien’s. Both drugs are found to induce a statistically significant increase in the “thrombocyte count” as compared to the corresponding controls. These effects are not real but to be attributed to an increase in particle count due to thrombocyte fragmentation as a consequence of drug application. There is no evidence for the claim that these drugs decrease the adhesiveness of thrombocytes.Numerical results of both tests often show a high and statistically significant correlation, especially following the addition of Ro 3-0837. Such is not true of individual blood samples to which no drug has been added. Evidentally, both tests are not specific for the same characteristic of normal blood platelets. But, when Ro 3-0837 is added, the breakdown of unstable platelets is induced; and the corresponding increase in count of thrombocyte fragments is expressed by both tests in the same fashion.

Combined cavernous and inferior petrosal sinus sampling in the differential diagnostic of ACTH-dependent Cushing's syndrome

2018 ◽  
Author(s):  
Natalia Gussaova ◽  
Uliana Tsoy ◽  
Alexander Savello ◽  
Natalia Plotnikova ◽  
Vladislav Cherebillo ◽  
...  
Keyword(s):  
Cushing’S Syndrome ◽  
Cushing's Syndrome ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling

Inferior petrosal sinus sampling – 16 years of experience from a single tertiary center in Israel

2020 ◽  
Author(s):  
Matan Fischer ◽  
Avivit Cahn ◽  
Benjamin Glaser ◽  
Gil Leibowitz ◽  
Joshua Stokar ◽  
...  
Keyword(s):  
Inferior Petrosal Sinus ◽  
Years Of Experience ◽  
Inferior Petrosal Sinus Sampling ◽  
Tertiary Center

Bilateral inferior petrosal sinus sampling in a cohort of patients with acth dependent cushing´s syndrome in a tertiary hospital

2020 ◽  
Author(s):  
García Moreno Rosa María ◽  
Parro Isabel Moreno ◽  
Sánchez David Ortiz ◽  
Remedios Frutos ◽  
Rioja Rubén Gómez ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Inferior Petrosal Sinus ◽  
Inferior Petrosal Sinus Sampling

Late-onset malignant glaucoma

2020 ◽  
Vol 3 ◽  
pp. 1
Author(s):  
Ramiro José Daud ◽  
Horacio Freile ◽  
Mauricio Freile ◽  
Soledad Mariano
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Acute Pain ◽  
Late Onset ◽  
Slit Lamp ◽  
Normal Range ◽  
Slit Lamp Examination ◽  
Complete Occlusion ◽  
Malignant Glaucoma ◽  
The Right

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.

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