ICEECE2012 Poster Presentations Neuroendocrinology (83 abstracts)
Basal and stimulated GH secretion in active cushing’s syndrome and 2 years after remission
A. Picu 1 , V. D’Angelo 1 , I. Karamouzis 1 , R. Berardelli 1 , E. Marinazzo 1 , B. Fussotto 1 , C. Zichi 1 , R. Giordano 2 , E. Ghigo 1 & E. Arvat 1
1University of Turin, Turin, Italy; 2University of Turin, Orbassano, Italy.
Impaired GH secretion occurs in Cushing’s syndrome (CS), reflecting hypothalamic and pituitary alterations, without IGF-I impairment. Obesity is known to blunt GH release, leading to BMI-related tests for GHD. Evaluation of GH in CS after remission is difficult, due to chronic previous hypercortisolism and persistent overweight. Aim of this study was to evaluate in 22 patients with Cushing’s syndrome (16 Cushing disease, CD, 6 adrenal adenomas, CS) GH response to GHRH+ARG during active disease and 2 years after surgical-induced remission, according to BMI-related cut-off levels. Basal IGF-I and pituitary function were also assayed. Active disease: 10 patients were obese (45%), 8 overweight (36%), 4 normal (18%). A severe GHD was shown in 12 patients (54%) (8 CD and 4 CS, 3 obese, 6 overweight and 3 normal). IGF-I were in the normal range. 8 CD showed 1 or multiple pituitary deficiencies.
Remission: 5 patients persisted obese (22,7%), 7 overweight (31%) and 10 became normal (45%). A severe GHD was shown in 8 patients (36%, CD only, 2 obese, 3 overweight, and 3 normal). 13 CD showed 1 or more pituitary deficiencies. No CS patient showed pituitary deficiencies. GHRH+ARG-induced GH levels were independent of either age/BMI. No correlation between GH peaks and HPA parameters were found, while IGF-I levels were positively correlated (P<0.01) with UFC during active disease and after surgery.
In conclusion: (1) CS shows an impaired GH release even according to BMI-related cut-off levels, together with a dissociation between GH and IGF-I secretion, due to a stimulatory cortisol action on the liver; (2) chronic hypercortisolism seems to override the influence of age and BMI on GH/IGF-I activity; (3) glucocorticoid-induced GHD is no longer evident 2 years after remission, thus suggesting that this could be a good time for the evaluation of GHD in patients suspected for surgery-induced hypopituitarism.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
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