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Epinephrine deficiency in hypocorticotropic hypopituitary children
Insights
Adrenocorticotropic hormone (ACTH) deficiency in children significantly reduces epinephrine levels, impacting adrenal function. Treatment with cortisol did not restore epinephrine levels in these patients.
Area of Science:
- Pediatric Endocrinology
- Neuroendocrinology
- Adrenal Gland Physiology
Background:
- Adrenal medullary synthesis of epinephrine is known to be impaired by ACTH deficiency in rats.
- The effect of ACTH deficiency on epinephrine synthesis in children and the impact of glucocorticoid replacement are not well-established.
- Catecholamine levels, including epinephrine and norepinephrine, play crucial roles in physiological responses.
Purpose of the Study:
- To evaluate plasma epinephrine and norepinephrine concentrations in children with various pituitary hormone deficiencies.
- To determine if ACTH deficiency specifically impacts epinephrine levels in children.
- To assess the effect of glucocorticoid replacement therapy on catecholamine levels in hypocorticotropic patients.
Main Methods:
- Plasma catecholamine concentrations (epinephrine and norepinephrine) were measured in 43 children aged 8-15 years.
- Children were divided into five groups: normals, isolated GH deficiency, GH/TSH deficiency, GH/TSH/ACTH deficiency, and idiopathic short stature.
- Measurements were taken at rest and after exercise, with ACTH and TSH deficiencies treated with cortisol and T4 replacement.
Main Results:
- Plasma norepinephrine levels were normal at rest and after exercise in all groups of short children.
- Resting and postexercise plasma epinephrine levels were significantly reduced (10-20% of normal) in children with ACTH deficiency (hypocorticotropic hypopituitarism).
- Epinephrine levels were normal in normal children and those with isolated GH deficiency or GH/TSH deficiency.
Conclusions:
- ACTH deficiency in children is associated with significantly reduced plasma epinephrine levels.
- Glucocorticoid replacement therapy does not normalize epinephrine levels in hypocorticotropic hypopituitary patients.
- These findings highlight a specific role for ACTH in regulating epinephrine synthesis or release in children.
Abstract:
In rats, adrenal medullary synthesis of epinephrine is impaired by ACTH deficiency and is not improved by replacement doses of glucocorticoid. We have evaluated plasma epinephrine and norepinephrine concentrations in 43 children, 8-15 yr old. These children were divided into 5 groups, with 6-10 per group: normals; children with isolated GH deficiency; hypopituitary children deficient in both GH and TSH; hypopituitary children deficient in GH, TSH, and ACTH; and short children without known organic disease. The deficiencies of ACTH and TSH were being treated with replacement doses of cortisol and T4. Plasma catecholamines were measured in the supine position at rest every other hour from 0800-1600 h, and after exercise in the standing position at 1000 h. Plasma norepinephrine levels, both at rest and after exercise, were normal in all four groups of short children. Resting and postexercise plasma epinephrine levels were reduced to 10-20% of normal in the hypocorticotropic hypopituitary patients, and were normal in the other three groups of short children.