Arlt W, Dahia P L, Callies F, Nordmeyer J P, Allolio B, Grossman A B, Reincke M
Department of Endocrinology, Medical University Clinic, Wüzburg, Germany.
Clin Endocrinol (Oxf). 1997 Nov;47(5):623-7. doi: 10.1046/j.1365-2265.1997.3091129.x.
A desmopressin-induced ACTH increase has been recently suggested to be specific for pituitary-dependent Cushing's disease. We present the case of a 47-year-old woman with Cushing's syndrome due to ectopic ACTH production by a bronchial carcinoid. While CRH failed to induce an ACTH or cortisol response, intravenous administration of desmopressin led to a 47% increase in serum ACTH and a 42% increase in serum cortisol concentration. After surgical removal of the tumour, the desmopressin response became negative. In vitro, ACTH production by tumour cells obtained at surgery was also stimulated by desmopressin but not by CRH. Additional receptor mRNA expression studies using RT-PCR revealed expression of both V2 and V3 vasopressin receptor subtypes in the carcinoid tumour at a level comparable to that recently described in pituitary corticotroph adenomas. This case illustrates that ACTH stimulation by desmopressin is not specific for pituitary-dependent Cushing's syndrome as vasopressin receptor subtypes known to interact with desmopressin may also be found in ectopic tumours producing ACTH.
最近有人提出，去氨加压素诱导的促肾上腺皮质激素（ACTH）升高是垂体依赖性库欣病所特有的。我们报告了一例47岁因支气管类癌产生异位ACTH导致库欣综合征的女性病例。虽然促肾上腺皮质激素释放激素（CRH）未能诱导ACTH或皮质醇反应，但静脉注射去氨加压素导致血清ACTH增加47%，血清皮质醇浓度增加42%。手术切除肿瘤后，去氨加压素反应变为阴性。在体外，手术时获得的肿瘤细胞产生的ACTH也受到去氨加压素的刺激，但不受CRH的刺激。使用逆转录聚合酶链反应（RT-PCR）进行的额外受体mRNA表达研究显示，类癌肿瘤中V2和V3血管加压素受体亚型均有表达，其水平与最近在垂体促肾上腺皮质激素腺瘤中描述的水平相当。该病例表明，去氨加压素对ACTH的刺激并非垂体依赖性库欣综合征所特有，因为已知与去氨加压素相互作用的血管加压素受体亚型也可能存在于产生ACTH的异位肿瘤中。
