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By Woodruff T.K.

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This is of relevance in cases of ectopic secretion of ACTH-like peptides by tumors. These tumors secrete the same type of precursors as the anterior pituitary (ACTH or p-lipotropin) but do not possess the enzymatic machinery of the intermediate lobe to cleave these big molecules into smaller cleavage products. Human ACTH is a linear polypeptide containing 39 amino acids. The basal level in the circulation ranges between 0 and 80 pg/ml. The ACTH secretion follows a diurnal rythm with a peak in the early hours of the morning, resulting in the diurnal rhythm of cortisol secretion.

In practice, however, such clear-cut patterns of separation have not emerged, minimizing the application of a single bolus of LHRH as a diagnostic test for this purpose. 6. Prolactin The main indications to obtain basal serum prolactin are (1) galactorrhea, (2) secondary amenorrhea with or without galactorrhea, (3) infertility, and (4) impotence. In all of these instances, the underlying problem can be related to a prolactin problem. When the hyperprolactinemia is mild, the abnormality can be missed in a single sample because of the pulsatile nature in prolactin secretion.

In contrast, approximately 70-80% of acromegalies demonstrate a brisk increase in their growth hormone levels following an intravenous bolus of TRH. g of intravenous TRH. The only conditions other than hypersomatotropism in whieh a HGH response to TRH may be seen are chronie renal failure and a rapid adolescent growth spurt. The confirmatory test for hypersomatotropism, of course, is the measurement of circulating somatomedin C levels in the plasma (Chapter 4). 2. Hyposomatotropism Hyposomatotropism, growth hormone deficiency, assumes primary importance in the evaluation of the child with growth retardation.

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Activin by Woodruff T.K.


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