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      Pyridostigmine Enhances Even if it Does Not Normalize the Growth Hormone Responses to Growth Hormone-Releasing Hormone in Patients with Cushing’s Disease

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          Subjects with Cushing’s disease have diminished growth hormone (GH) response to growth hormone-releasing hormone (GHRH). The aim of our study was to investigate the underlying mechanism of this diminished GH response in these patients using pyridostigmine (PD), an acetylcholinesterase inhibitor, which is reported to increase GH secretion by reducing somatostatin tone. Eight subjects with untreated Cushing’s disease (caused by a pituitary adenoma) and 6 control subjects received GHRH 100 µg in 1 ml of saline, as intravenous bolus injection 60 min after (1) placebo (2 tablets, p.o.) or (2) PD (120 mg, p.o.). After GHRH plus placebo, the GH peak (mean ± SEM) was significantly lower in subjects with Cushing’s disease (2.4 ± 0.5 µg/l) compared to control subjects (25.1 ± 1.8 µg/l, p < 0.05). After GHRH plus PD, the GH peak was significantly enhanced both in subjects with Cushing’s disease (7.1 ± 2.3 µg/l, p < 0.05) and in control subjects (42.3 ± 4.3 µg/l, p < 0.05). In patients with Cushing’s disease, the GH response to GHRH plus PD was lower with respect to the GH response to GHRH alone in normal subjects. We conclude that hypercortisolism may cause a decrease in central cholinergic tone which is in turn hypothesized to be responsible of an enhanced somatostatin release from the hypothalamus. However, other metabolic or central nervous system alterations may act synergistically with hypercortisolism in causing GH inhibition in patients with Cushing’s disease.

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          Author and article information

          Horm Res Paediatr
          Hormone Research in Paediatrics
          S. Karger AG
          02 December 2008
          : 35
          : 3-4
          : 99-103
          Cattedra di aClinica Medica and cChimica, Università di Brescia, Italia bServizio di Endocrinologia, Ospedale Fatebenefratelli, Milano, Italia; dDepartment of Health Sciences, University of Wisconsin, Milwaukee, USA
          181882 Horm Res 1991;35:99–103
          © 1991 S. Karger AG, Basel

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          Pages: 5
          Original Paper


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