ACROMEGALY DUE TO PRODUCTION OF A GROWTH HORMONE RELEASING FACTOR BY A BRONCHIAL CARCINOID TUMOUR

We have studied growth hormone production in a patient with a bronchial carcinoid and acromegaly. The absence of growth hormone from the carcinoid tumour was demonstrated by extraction, cell culture and immunoperosidase techniques. Using a linked perfusion culture system, effluent from the bronchial carcinoid tumour culture stimulated a rapid release of growth hormone from a rat pituitary monolayer. This is the first time evidence of growth hormone releasing activity by a bronchial carcinoid has been demonstrated in a production.     

Growth hormone releasing factor, somatocrinin, releases pituitary growth hormone in vitro.

Purified (rat) hypothalamic growth hormone releasing factor (GRF), native human GRF isolated from an islet cell tumor of the pancreas that had caused acromegaly, and the synthetic replicates of the human material are potent secretagogues of immunoreactive growth hormone (GH) by primary cultures of rat pituitary cells. Native or synthetic peptides give identical dose-response curves, with identical slopes and identical maximal effects. The median effective dose of the tumor-derived GRF is 15 x 10(-12) M. The effect of hypothalamic GRF or of a synthetic replicate of tumor-derived GRF is immediate, being demonstrable in less than or equal to 30 sec after contact in a pituitary cell perifusion system. The effect of hypothalamic GRF or of tumor-derived GRF is highly specific for stimulating release of immunoreactive growth hormone; there is no demonstrable concomitant effect on the secretion of other pituitary hormones. Somatostatin-28 and somatostatin-14 inhibit the release of growth hormone produced by hypothalamic GRF or tumor-derived GRF in typical noncompetitive antagonism. On the basis of the results reported here, hypothalamic GRF and tumor-derived GRF are qualitatively indistinguishable in their ability to stimulate the secretion of immunoreactive growth hormone in vitro. The name "somatocrinin" is proposed to replace the acronym GRF.     

Growth hormone-releasing factor regulates growth hormone mRNA in primary cultures of rat pituitary cells.

A peptide with high intrinsic activity for specifically stimulating the secretion of immunoreactive growth hormone (GH; somatotropin) has been characterized and reproduced by total synthesis. This peptide, human pancreatic growth hormone-releasing factor, 44-amino-acid form (hpGRF1-44-NH2), was isolated from a tumor localized in the pancreas of a patient with acromegaly. We report here the effect of this growth hormone-releasing factor (GRF) on GH release and the GH mRNA levels in monolayer cultures of rat pituitary. The cytoplasmic dot hybridization technique was used to examine the effect of GRF on GH mRNA levels. Incubation of rat pituitary cultures with GRF for 72 hr resulted in a 2- to 2.5-fold increase in GH mRNA levels, and the maximal levels of stimulation were achieved at GRF concentrations as low as 1 fM. GRF did not stimulate prolactin release, nor did it affect specific prolactin mRNA levels in the pituitary cultures. We conclude that GRF is a potent and specific GH secretagogue that also affects specifically GH mRNA levels in normal pituitary cells.     

Acromegaly caused by ectopic growth hormone-releasing hormone production from a bronchial carcinoid tumor

Acromegaly is usually caused by a growth hormone (GH)-secreting pituitary adenoma. In rare cases, however, it is caused by the ectopic production of growth hormone-releasing hormone (GHRH). We report a case of acromegaly due to ectopic production of GHRH from a bronchial carcinoid in a 42-year-old female. The carcinoid tumor was successfully treated with bilobectomy.     

POTENTIAL USES OF HUMAN PANCREATIC GROWTH HORMONE-RELEASING FACTOR 1-44 AMIDE

A family of growth hormone releasing peptides have been isolated and characterized from human pancreatic islet cell tumours. We have compared the growth hormone release in normal volunteers and patients with various hypothalamo-pituitary disorders, following direct stimulation of the pituitary using 50μg of the most potent homologue, hp GRF 1-44 amide i.v. with that following indirect stimulation using oral clonidine 0-15 mg/m², which depends on intact hypothalamic mechanisms. These tests both produced a wide variation in GH response in normal volunteers, considerable GH release following hp GRF 1^44 amide but little after clonidine in idiopathic GH deficiency, and indistinguishable, negligible responses in patients with craniopharyngiomas and pituitary tumours associated with GH deficiency. Two untreated acromegalics showed GH increments in the normal range despite elevated basal levels. It is concluded that hp GRF 1-44 amide is of limited diagnostic value by itself, but may be of considerable therapeutic use in patients with idiopathic GH deficiency.     

Acromegaly associated with a bronchial carcinoid tumor: evidence for ectopic production of growth hormone-releasing activity.

A patient with acromegaly, pituitary enlargement, and elevated plasma GH levels also had a bronchial carcinoid tumor. Signs and symptoms of active acromegaly along with elevated GH levels persisted for 11 yr after hypophysectomy and pituitary stalk section. Resection of the bronchial carcinoid reduced plasma GH to barely detectable levels. Extracts of the frozen carcinoid tumor were devoid of significant GH, but when added to isolated pituitary cells of estrogen-primed male rats in 4-day primary culture exhibited specific GH-releasing activity in vitro. These findings strongly suggest that the patient's acromegaly resulted from continual stimulation of pituitary somatotrophs by a GH-releasing factor secreted by the bronchial carcinoid.     

Reduction of pituitary size by the somatostatin analogue SMS 201-995 in a patient with an islet cell tumour secreting growth hormone releasing factor

Acromegaly is rarely caused by the ectopic secretion of growth hormone releasing factor (GRF) from peripheral neuroendocrine tumours. We evaluated the ability of a recently developed somatostatin analogue (SMS 201-995, Sandoz) to reduce hormone levels and pituitary size in a young woman with acromegaly and Zollinger-Ellison syndrome secondary to a metastatic pancreatic islet cell tumour secreting GRF and gastrin. Gastrin, GRF, and growth hormone (GH) levels declined dramatically following the initiation of therapy with the analogue by continuous iv infusion. Although intermittent sc therapy was not effective in suppressing hormone levels, continuous sc infusion of SMS 201-995 has provided good control of both GRF and GH levels for nine months. Moreover, treatment with SMS 201-995 was associated with a substantial reduction in pituitary enlargement and an improvement in her gastric symptoms. Continuous sc infusion of SMS 201-995 may be useful in treating enlarged pituitaries resistant to other modes of therapy.     

Down-regulation of growth hormone releasing factor receptors following continuous infusion of growth hormone releasing factor in vivo

The in vivo chronic infusion of growth hormone releasing factor (GRF) results in a loss of the pituitary growth hormone (GH) response to GRF as well as in a substantial depletion of pituitary GH content. To evaluate if the loss in response is due to the down-regulation of GRF receptors the specific GRF binding capacity of pituitary homogenates prepared from rats infused with saline or GRF (1 or 15 micrograms/h for 24 h) was determined. The pituitary binding capacity of animals infused with GRF was significantly reduced as compared to animals infused with saline.     

ACROMEGALY CAUSED BY PULMONARY CARCINOID TUMOURS

Two patients are described whose acromegaly was cured by removal of a bronchial carcinoid tumour. One had an enlarged pituitary fossa and evidence is presented that in this patient the tumour was not secreting growth hormone. The evidence available suggests that the tumour was producing a growth hormone releasing substance. It is suggested that some cases of the pluriglandular syndrome may be secondary to small bronchial carcinoid tumours that produce substances as yet unidentified, that stimulate the growth and hyperactivity of other endocrine tissue.     

Interaction of carp growth hormone-releasing factor and somatostatin on in vitro release of growth hormone in rainbow trout (Oncorhynchus mykiss).

Possible antagonism between somatostatin (SS) and carp growth hormone-releasing factor (GRF) on growth hormone (GH) secretion was examined by radioimmunoassay in a dispersed rainbow trout pituitary cell culture system. SS (3 nM) significantly antagonized carp GRF(1-29; 1 nM, 10 nM)-induced GH secretion. The slope of the dose-response curve for carp GRF(1-29) with SS was statistically different from that of carp GRF(1-29) alone (p less than 0.05) suggesting a noncompetitive antagonism of SS to carp GRF. The carp GRF(1-29) was also indicated to be a noncompetitive antagonist to SS (p = 0.056). Carp GRF(1-29; 100 nM) was unable to restore the inhibitory effect of SS on GH release after pre-exposure of SS (30 nM) to the pituitary cells. We conclude that SS antagonizes carp GRF on GH release at the pituitary level in rainbow trout and this antagonism is noncompetitive. SS has a postantagonism to carp GRF which may implicate some important physiological adaptations in teleosts.     

Plasma growth hormone response to human growth hormone releasing factor in rats administered with chlorpromazine and antiserum against somatostatin. Effects of hypo- and hyperthyroidism

The effect of hypo- and hyperthyroidism on the plasma growth hormone (GH) response to synthetic human growth hormone releasing factor (GRF) was determined in conscious, freely moving rats pretreated with chlorpromazine and antiserum against somatostatin. Chlorpromazine plus somatostatin antiserum pretreated rats gave consistent response to GRF which was not observed in untreated rats. Chlorpromazine alone has no effect on GH secretion induced by GRF in rat pituitary monolayer culture. In rats made hypothyroid by thyroidectomy, both basal and peak plasma GH responses to a small (0.25 microgram/kg bw) and a moderate dose of GRF (1 microgram/kg bw) were significantly reduced as compared to controls. In rats made hyperthyroid by the administration of thyroxine, basal and peak plasma GH responses to a small but not to a moderate dose of GRF were significantly reduced as compared to controls. A reduced plasma GH response to a small dose of GRF was observed 8 days after the cessation of thyroxine administration. The pituitary GH reserve was markedly reduced in hypothyroid but not in hyperthyroid rats as compared to their respective controls. These results indicate that plasma GH response to GRF is reduced both in hypo- and hyperthyroidism. The mechanism involved in the phenomenon appears to be different between the two conditions.     

The interrelationship between the effects of somatostatin and human pancreatic growth hormone-releasing factor on growth hormone release by cultured pituitary tumor cells from patients with acromegaly

The effects of somatostatin (SRIF) and human pancreatic tumor GRF on GH release by cultured pituitary tumor cells obtained during transsphenoidal operation from 15 acromegalic patients were investigated. In a study of the sensitivity of pathological GH release to SRIF, 1-10 nM SRIF induced maximal inhibition of hormone release in 3 consecutive tumors. In 12 of 15 tumor cell cultures, 10 nM SRIF produced statistically significant inhibition of basal GH release by 39 +/- 3% (mean +/- SEM). In 2 of the 3 other tumors, SRIF inhibited GRF-stimulated GH release, while this was not investigated in the third tumor. A dose-response study of the effect of GRF on GH release by cultured pituitary tumor cells showed that doses of 0.1, 1, 10, and 100 nM induced similar maximal (35%) stimulation of hormone secretion. In four of five consecutive tumor cell suspensions, 1 and 10 nM GRF induced statistically significant GH stimulation by 18-300%. Preincubation of the tumor cells with 5 nM dexamethasone greatly increased the sensitivity and the maximal stimulation in response to GRF and made one tumor cell suspension, which did not react to GRF initially, sensitive to GRF. In the tumors of four patients, the interrelationship between the effects of SRIF and GRF on GH release were also studied. SRIF (10 nM) inhibited the stimulatory effects of GRF on GH release virtually completely. In conclusion, GH release by in vitro cell cultures of GH-secreting pituitary adenomas was inhibited by SRIF and stimulated by GRF. The interaction of GRF and SRIF on GH release by these pituitary tumor cells was similar to that in normal rat GH cells, as SRIF virtually completely overcame the GRF-induced GH release.     

In vitro responses of rainbow trout (Oncorhynchus mykiss) somatotrophs to carp growth hormone-releasing factor (GRF) and somatostatin

To study the hypothalamic control of growth hormone (GH) release in lower vertebrates, we employed an in vitro technique using a monolayer cell culture system of rainbow trout pituitary glands. Two newly purified carp brain growth hormone-releasing factors, carp GRF(1-45) and carp GRF(1-29), and synthetic somatostatin-14 (SST-14) were applied to the cultured pituitary cells. The results indicate that: (1) The carp GRFs had a dose-related potency in stimulating growth hormone release. The dose of half maximum effect (ED50) for carp GRF(1-45) was 0.107 nM, and an equal potency for carp GRF(1-29) was 0.388 nM. (2) SST-14 inhibited GH release having a dose-dependent potency with an ED50 of 0.186 nM. (3) Osmotic pressure did not influence SST-14 inhibited GH secretion but did affect spontaneous GH release. (4) The response of cultured cells was not affected by length of incubation period with SST-14 or carp GRF but was affected by cell density.     

SUCCESSFUL TREATMENT BY CHEMOTHERAPY FOR ACROMEGALY ASSOCIATED WITH ECTOPIC GROWTH HORMONE RELEASING HORMONE SECRETION FROM A CARCINOID TUMOUR

Acromegaly secondary to the secretion of ectopic growth hormone releasing hormone (GHRH) is rare. We have documented the presentation and unusual clinical course of a patient with a disseminated GHRH-secreting bronchial carcinoid tumour associated with acromegaly over a 17-year period. Recurrent widespread metastatic lesions have been treated over a 10-year period by repeated cycles of the nitrosourea CCNU and 5-fluorouracil with evidence of tumour regression and reduction of circulating growth hormone (GH) and urinary 5HIAA excretion. This cytotoxic regimen, which has been well tolerated, may prove valuable in the management of disseminated carcinoid tumours.     

Serum growth hormone in patients with carcinoid tumours; basal levels and response to glucose and thyrotrophin releasing hormone

The regulation of serum growth hormone was studied in 33 consecutive patients with carcinoid tumours; both diurnal serum GH and GH responses to an i.v. glucose load and TRH were assessed. Seventeen of the patients (52%) showed disturbed regulation of serum GH and 10 had at least two abnormal tests. Four patients had clinically overt acromegaly. The diurnal mean serum GH levels were higher (P less than 0.001) in patients with carcinoid tumours than in control subjects and more than one third (41%) had levels in a range similar to that of acromegalic patients without carcinoid tumours. The disturbance in serum GH regulation might have been caused in some patient by tumour secreted growth hormone releasing factor(s) which act directly on pituitary somatotrophs, but other tumour-related non-specific stimulation must be considered. Carcinoid tumours should be considered in the aetiology of acromegaly.     

Bovine pituitary cells exhibit a unique form of somatotrope secretory heterogeneity

Use of reverse hemolytic plaque assays revealed that, as in the rat, bovine somatotropes are functionally heterogeneous with respect to regulated GH release. Uniquely, this heterogeneity is manifested by the appearance of a distinct subpopulation of GH cells that release hormone only in the presence of the hypothalamic secretagogues GRF and/or TRH. Although these cells did not release GH in the absence of stimulatory agents, immunocytochemical detection of GH demonstrated these cells were capable of hormone storage. The relative abundance of silent somatotropes varied according to the hypothalamic secretagogue applied to the culture (GRF and/or TRH) and the physiologic state of the tissue donor. In cell cultures obtained from castrated males, 4.2 +/- 1.2%, 3.0 +/- 0.7%, and 6.8 +/- 1.2% (mean +/- SEM; n = 14) of all pituitary cells were induced to release detectable amounts of GH by GRF, TRH, and GRF/TRH, respectively. When pituitary cells obtained from gonad-intact males (n = 4) and females (n = 4) were tested, only incubation with GRF (14.1 +/- 2.5%; 6.9 +/- 2.3%, respectively) and GRF/TRH (15.2 +/- 2.4%; 9.2 +/- 2.6%, respectively) stimulated a significant population of these silent cells. A combined analysis of the proportion of GH secretors and the relative amount of hormone released per cell revealed that a substantial fraction of the GH secreted in vitro after stimulation is attributable to the recruitment of silent somatotropes into the secretory pool. Taken together, these results reveal the existence of a unique form of GH cell heterogeneity--the silent somatotrope. Moreover, our findings demonstrate that this somatotrope population could provide a cellular basis for the readily releasable pool of GH in the bovine pituitary.     

Changes in growth hormone secretion in spontaneously hypertensive rats

Secretion of the growth hormone (GH) in spontaneously hypertensive (SH) male rats has been determined and compared with that of normotensive Wistar-Kyoto (WKY) controls. In a first set of experiments, plasma GH concentration and pituitary GH content were measured in SH rats 30, 60 and 90 days old. 30-day rats showed reduced GH plasma and pituitary levels, whereas in 60- and 90-day-old rat no differences in GH plasma concentration and increased GH pituitary content were observed. In a second set of experiments, 90-day-old SH male rats anesthetized with sodium pentobarbital and intravenously injected with growth hormone-releasing factor (GRF) showed an amplitude and duration of response to injected hormone higher than WKY controls. In a third set of experiments, hemipituitaries of 90-day-old SH males were incubated for 2 h in Krebs-Ringer-bicarbonate either in the presence or in the absence of GRF. In the absence of GRF stimulation, the in vitro release of GH was higher than in WKY controls, whereas in the presence of GRF the sensitivity and the maximum response to GRF was reduced in comparison with normotensive male rats. These results indicate that SH rats have decreased pituitary content and plasma GH concentration before puberty. Besides, they showed increased pituitary GH content in adulthood and opposite changes in the in vivo and in vitro response to GRF.     

A DIVERGENCE OF PLASMA GROWTH HORMONE RESPONSE BETWEEN GROWTH HORMONE-RELEASING FACTOR AND INSULIN-INDUCED HYPOGLYCAEMIA AMONG MIDDLE-AGED HEALTHY MALE SUBJECTS

The capability of the anterior pituitary gland to secrete GH in response to an intravenous injection of growth hormone-releasing factor (GRF) and insulin-induced hypoglycaemia was evaluated in 9 healthy male subjects ranging in age between 37 and 52 years old. Plasma GH response to 100 micrograms human GRF showed considerable intersubject variation and the increment of the peak value from the basal did not exceed 5 ng/ml in four out of 9 subjects. In contrast, insulin-induced hypoglycaemia resulted in a consistent stimulation of GH that exceeded 21 ng/ml in all subjects. The mean peak GH response after insulin-induced hypoglycaemia was significantly higher than that after GRF (27.4 +/- 1.6 vs 10.6 +/- 1.9 ng/ml). These results demonstrate that a significant divergence exists in plasma GH responses between the two provocative tests in the middle-aged subjects and suggest that the stimulation of GH following insulin-induced hypoglycaemia is not mediated solely by endogenous GRF.     

Acromegaly and bronchial carcinoid. Effect of removal of the latter

A patient with a long-standing history of bronchial carcinoid and acromegaly was studied. There was pituitary enlargement with an intrasellar mass (brain computed tomography scan), high basal GH levels, and abnormal GH and other pituitary hormones response to oral glucose and a combined test (LHRH, TRH, insulin). After resection of the bronchial carcinoid, basal GH was normal, GH was normally suppressed during OGTT, pituitary function was within expected normal range, and there was regression of the pituitary tumor together with clinical improvement. These data suggest that the patient's acromegaly was secondary to pituitary stimulation due to the bronchial carcinoid.     

Iso stimulation of GH and cAMP: comparison of beta-adrenergic- to GRF-stimulated GH release and cAMP accumulation in monolayer cultures of anterior pituitary cells in vitro

Growth hormone (GH) release and cAMP content were measured in monolayer cultures of anterior pituitary cells after beta-adrenergic and GH-releasing factor (GRF) receptor activation. Isoproterenol (Iso, ED50-20 nM) was less potent than GRF (ED50-20 pM) in stimulating GH release. Iso caused a rapid stimulation of GH release that was maximal after 15 min and declined thereafter, while GRF caused a more gradual increase in GH secretion that was maximal after 30 min and remained elevated after 3 h. Both Iso- and GRF-stimulated GH release were preceded by an increase in cAMP content in the pituitary cells. Further, the addition of 3-isobutyl-1-methylxanthine (IBMX) to the medium enhanced the GH-stimulatory and cAMP-accumulating effects of both secretagogues. Experiments performed with native catecholamines and synthetic catecholamine agonists and antagonists indicated that the GH-stimulatory effect of Iso was mediated by a mixed population of beta 1-adrenergic and beta 2-adrenergic receptors. Additionally, experiments performed with cultured GH3 tumor cells, found that incubation with GRF, Iso, vasoactive intestinal polypeptide, forskolin, or cholera toxin caused an increase in cAMP content in the cells. However, compared to the responses observed in primary pituitary cultures the GH secretory response to these agents was comparatively small. Together, these studies suggest that a mixed population of beta 1-adrenergic and beta 2-adrenergic receptors may act, at least in part, on somatotrophs in the anterior pituitary to stimulate GH release. Although both GRF and beta 2-adrenergic receptor agents affect GH release through a common second messenger system, their differing pharmacokinetic properties suggest distinct intracellular mechanisms.