Evidence for gamma-MSH-like immunoreactivity in ectopic ACTH-producing tumors

Using a specific radioimmunoassay for gamma-MSH, a predicted peptide in the cryptic N-terminal portion of the adrenocorticotropin-beta-lipotropin precursor, gamma-MSH-like immunoreactivity (gamma-MLI) was detected in two ectopic ACTH producing tumors. Gel chromatographic studies on Bio-Gel P-60 revealed one or two peaks of gamma-MLI; one was eluted near th elution position of beta-LPH, compatible with gamma-MLI in human pituitary and the other emerged near the position of beta-endorphin. These results indicate that ectopic ACTH-producing tumors eleborate not only ACTH, beta-endorphin but also gamma-MLI.     

Effects of repetitive administration of corticotropin-releasing hormone combined with lysine vasopressin on plasma adrenocorticotropin and cortisol levels in secondary adrenocortical insufficiency

To examine the functioning of the hypothalamo-pituitary-adrenocortical axis in secondary adrenocortical insufficiency, we administered 100 micrograms synthetic human CRH, iv, plus 10 U lysine-8-vasopressin (LVP), im, three times daily for 3 consecutive days. The changes in plasma ACTH and cortisol levels during the administration and the response to an insulin tolerance test (ITT) conducted before and after the administration were determined. In three patients with isolated ACTH deficiency, basal plasma ACTH and cortisol levels were undetectablly low, and there was no response noted in the ITT or during CRH-LVP administration throughout the observation period. In four patients with adrenocortical insufficiency who had undergone successful transsphenoidal microadenomectomy for Cushing's disease and in six patients who had undergone curative unilateral adrenalectomy for Cushing's syndrome, basal plasma ACTH levels were low, but responded considerably to both stimulation tests. Along with the 3 days of CRH-LVP stimulation, however, neither the peak nor the time-integrated ACTH response was significantly enhanced, because of the variability of the responses among the patients. Compared with the ACTH response on the last day of CRH-LVP stimulation, the subsequent ITT tended to induce a lower ACTH response in the post-Cushing's disease patients and a higher response in the post-Cushing's syndrome patients. Regarding the plasma cortisol levels, the basal, peak, and integrated responses tended to increase daily during CRH-LVP administration. Conversely, the ITT after repetitive CRH-LVP administration induced a higher cortisol response than the test before CRH-LVP administration in the post-Cushing's disease patients. No serious complications were noted in any of the patients during or after the treatment. The present findings indicate that 1) repetitive administration of CRH in combination with LVP is a safe and valuable provocation test to examine the pituitary ACTH reserve and the integrity of the pituitary-adrenocortical axis; 2) isolated ACTH deficiency is usually due to a defect at the pituitary level; 3) with respect to adrenocortical responsiveness, post-Cushing's disease patients show a better accumulation of the provocative effect than do post-Cushing's syndrome patients; and 4) both hypothalamic and pituitary dysfunction are responsible for adrenal hypofunction in patients after hypercortisolemia, but post-Cushing's syndrome patients (especially those with a short period of hypercortisolemia) appeared to have less impairment of hypothalamic ACTH-releasing activity than post-Cushing's disease patients.     

Chronic effects of interleukin-1 on hypothalamus, pituitary and adrenal glands in rat

To assess the chronic effects of interleukin-1 (IL-1) and IL-2 on the hypothalamo-pituitary-adrenal axis in vivo, we administered recombinant human (rh) IL-1 alpha, rhIL-1 beta or rhIL-2 (2.0 micrograms/day) repetitively to adult male rats for 10 days. In rhIL-1 beta-treated rats, adrenocorticotropic hormone-like immunoreactivity (ACTH-LI) of the anterior pituitary appeared to increase first on day 3 followed by an increase of corticotropin-releasing hormone (CRH)-LI both in the hypothalamus and in the adrenal gland after day 7. At the end of the 10-day treatment, wet weights of the adrenal glands of rhIL-1 beta-treated rats increased significantly compared with those of control rats. Plasma ACTH levels in rhIL-1 beta-treated rats at the sampling time continued to be elevated throughout the experimental period. Under the same experimental design, rhIL-1 alpha increased plasma ACTH levels at the sampling time without changes in adrenal weight or in the peptide contents investigated. The same amount of rhIL-2 had no effect on these measured variables during the 10-day treatment. These data indicate that the repetitive administration of IL-1 beta resulted in chronic effects in the hypothalamo pituitary-adrenal axis to increase the activities in these organs during the treatment and, moreover, IL-1 possibly has a positive direct effect on the CRH-containing cells in the adrenal glands.     

Hematologic malignancies in the Japanese patients with inflammatory bowel disease

Background

Although attention has been focused for over 20 years on the possible increased risk for hematologic malignancies (HM) in patients with inflammatory bowel diseases (IBD) receiving immune-modulators or anti-TNF-alpha antibodies, the association is still controversial. To understand the actual conditions of HM in the Japanese patients with IBD, the research committee for IBD supported by the Ministry of Health, Welfare and Labor of Japan (IBD-MHWL) conducted a multi-center retrospective study.

Methods

Questionnaires for the development of HM in IBD patients were sent to the 70 facilities participating with IBD-MHWL in the first survey, followed by the second survey using a more detailed questionnaire, sent to the 27 members with HM patients.

Results

Out of a total of 36,939 IBD patients in 70 facilities, 28 cases of HM related with IBD [12 of 10,500 UC patients (0.11 %), 16 of 6,310 CD patients (0.25 %)] were analyzed. The numbers of UC patients who developed HM were 2 (0.15 %) from the group receiving and 10 (0.13 %) from the group non-receiving thiopurine, without significant differences. The numbers of CD patients who developed HM were 4 (0.39 %) from the group receiving and 12 (0.21 %) from the group non-receiving thiopurine, without significant differences. The odds ratios of developing HM by thiopurine were 1.37 (95 % CI 0.30–6.24) in UC patients and 1.86 (95 % CI 0.60–5.78) in CD patients.

Conclusions

Our results suggested that thiopurine therapy may not be a risk factor for HM in Japanese patients with IBD. Further accumulation of cases and prospective studies are necessary to conclude this important issue.     

Combination with third‐generation bisphosphonate (YM529) and interferon‐alpha can inhibit the progression of established bone renal cell carcinoma

The aim of this study was to investigate whether the third‐generation nitrogen‐containing bisphosphonate (YM529) can inhibit the progression of established bone renal cell carcinoma (RCC) and to elucidate its mechanism. Antiproliferative effect and apoptosis induction of RCC cells and mouse osteoclasts by YM529 and/or interferon‐alpha (IFN‐α) were evaluated in vitro using cell counting and in vivo using soft X‐ray, the TUNEL method and tartrate‐resistant acid phosphatase stain. For the in vivo study, male athymic BALB/cA Jc1‐nu nude mice bearing human RCC cell line RBM1‐IT4 cells were treated with YM529 and/or IFN‐α. The biological activity of osteoclasts was evaluated using the pit formation assay. The antiangiogenetic effect by YM529 and/or IFN‐α was analyzed using micro‐vessel density and in situ mRNA hybridization. Osteoclast number in bone tumors was decreased in YM529‐treated mouse. YM529 also inhibited osteoclast activity and proliferation in vitro, whereas basic fibroblast growth factor expressions and micro‐vessel density within tumors were inhibited by IFN‐α. Neither YM529 nor IFN‐α alone significantly inhibited the growth of established bone metastatic tumors. Combined treatment with YM529 and IFN‐α may be beneficial in patients with human RCC bone metastasis. Their effects are mediated by osteoclast recruitment inhibition and inactivation by YM529 and antiangiogenesis by IFN‐α.     

A case of an exogastric developing-type carcinoma of the stomach and a review of thirty nine cases reported in Japan

One personally handled case of an exogastric developing-type carcinoma of the stomach and 39 other cases reported in Japan are discussed in this study. Twenty-seven cases mainly involved an abdominal tumor. As to the developing region, it was frequently in the greater curvature of the antrum. By tissue type, many undifferentiated medullary cancers were noted. With regard to treatment, many researchers recommend the excision of the other complicated organs. Survival for more than postoperative 1 year were as few as 4 cases, including the case handled.     

Recurrent fibrolamellar hepatocellular carcinoma with biliary invasion: Successful resection

A jaundiced 17-year-old man was diagnosed as having a local recurrence of fibrolamellar hepatocellular carcinoma 2 years and 4 months after left hepatic trisegmentectomy with total caudate lobectomy had been performed. The patient had a tumor occupying the upper part of the extrahepatic and intrahepatic bile ducts. Complete resection of the recurrent tumor was carried out. The patient remains well 3 years after the second surgery. Fibrolamellar hepatocellular carcinoma, a rare type of liver cancer, is a well defined disease entity with distinct clinical and histopathological features and a favorable prognosis. The good prognosis seems to warrant aggressive surgical intervention in patients with recurrences. Therefore, additional surgery for tumor recurrence should be considered. To our knowledge, this is the first report of a case in which a recurrent tumor of fibrolamellar hepatocellular carcinoma invaded the entire bile duct wall was successfully resected.     

Distribution and characterization of immunoreactive corticostatin in the hypothalamic-pituitary-adrenal axis.

Using an antiserum against synthetic rabbit corticostatin-1 (CS-1), we established a specific RIA for CS-1 and examined its distribution in various tissues, including the hypothalamic-pituitary-adrenal axis. Among the tissues examined, the highest levels of CS-1-like immunoreactivity (-LI) were found in the lung and spleen. CS-1-LI was also detected at relatively high levels in the pituitary, adrenal medulla, and small intestine, while it was barely detectable in the hypothalamus. Immunocytochemical studies revealed the widespread distribution of CS-1 in these tissues. Plasma CS-1 levels averaged 7.8 ng/ml and increased to 185.4 ng/ml in the presence of infection. CS-1-LI in the adrenal gland, small intestine, and hypothalamus also increased in rabbits with active inflammation. These data suggest that CS-1 may modify the hypothalamic-pituitary-adrenal axis in an endocrine or paracrine manner in response to infection.     

Thyroid carcinoma and hot nodule

A 70-year-old woman presented with a nodule in the thyroid gland. ¹³¹I scintigraphy of the gland showed a hot nodule. Histology of the resected thyroid revealed a papillary adenocarcinoma. Although a thyroid carcinoma with a hot nodule seen on the radioiodine isotope scan is a very rare occurrence, it is clinically very important because it may indicate a thyroid malignancy.