Effect of withdrawal of somatostatin plus growth hormone (GH)‐releasing hormone as a stimulus of GH secretion in Cushing's syndrome

Summary Objective Somatostatin (SS) may not merely be inhibitory to GH secretion but, under appropriate temporal conditions, may act in a paradoxically positive manner to sensitize somatotroph responsiveness to GHRH. SS infusion withdrawal (SSIW) produces a rebound GH rise in humans and increases GHRH‐induced GH release. Theoretically SSIW leaves the somatotroph cell in a situation of low endogenous SS. In Cushing's syndrome, GH secretion appears blunted to all stimuli. The mechanisms by which glucocorticoids impair GH secretion in Cushing's syndrome are unknown. There are no data evaluating GH responsiveness to SSIW plus GHRH in Cushing's syndrome patients. The aim of the present study was to evaluate the GH response to SSIW plus GHRH in a group of Cushing's syndrome patients, in order to further understand the deranged GH secretory mechanisms in Cushing's syndrome. Patients and Measurements Eight female patients with Cushing's syndrome were studied. As a control group, eight normal subjects of similar age and sex were studied. Three tests were done. On one day, SS intravenous (i.v.) infusion (500 µg for 0–90 min) was performed followed by placebo i.v. bolus at min 90 after SS withdrawal (SSIW). On another day, SS i.v. infusion (500 µg for 0–90 min) was performed followed by GHRH (100 µg) i.v. bolus at min 90 after SS withdrawal. On a third day, slow infusion of 150 mmol/l NaCl administration was performed followed by GHRH (100 µg) i.v. bolus at min 90 after the start of the infusion. Blood samples were taken at appropriate intervals for determination of GH. Results GHRH‐induced GH secretion in normal subjects showed a mean peak of 15·4 ± 2·1 µg/l (conversion factor: 1 µg/l = 1·2 mUI/l). Normal control subjects had a mean peak of 3·3 ± 1·6 µg/l after SSIW‐induced GH secretion. When GHRH was administered after SSIW there was increased GH secretion with a mean peak of 23·7 ± 4·2 µg/l significantly greater than the response after SSIW alone ( P < 0·05) and GHRH alone ( P < 0·05). The patients with Cushing's syndrome had a blunted GH response after GHRH administration with a mean peak of 1·4 ± 0·4. After SSIW, Cushing's syndrome patients had a mean peak of 1·0 ± 0·5 µg/l. When GHRH was administered after SSIW there was a similar GH response with a mean peak of 1·7 ± 0·6 µg/l, not statistically different than the response after SSIW alone ( P = ns) and GHRH alone ( P = ns). When we compare the response of normal subjects and Cushing's syndrome patients, after SSIW plus GHRH, it was decreased in Cushing's syndrome patients ( P < 0·05), with a mean GH peak of 23·7 ± 4·2 µg/l and 1·7 ± 0·6 µg/l for normal subjects and Cushing's syndrome patients, respectively. Conclusions This study has demonstrated a significantly blunted peak GH response to somatostatin infusion withdrawal plus GHRH in Cushing's syndrome patients. In this theoretical situation of decreased somatostatinergic tone there is persistence of GH hyposecretion in Cushing's syndrome, suggesting the existence of a pituitary defect responsible for the decreased GH secretion in Cushing's syndrome.