Abstract:
OBJECTIVE:It has previously been shown that patients with postpartum pituitary necrosis (Sheehan's syndrome, SS) have paradoxically increased TSH levels and loss of the nocturnal TSH surge. This study sought to determine the circadian and pulsatile characteristics of TSH secretion underlying those abnormalities. DESIGN AND PATIENTS:Chronobiological and cluster analyses of 24-h TSH profiles were performed in nine SS patients (43-61 years, median = 52 years) and nine healthy female controls (33-47 years, median = 42 years). MEASUREMENTS:Serum concentrations of T3, T4, free T4 (fT4) and cortisol were measured by radioimmunoassay; TSH, GH, PRL and LH were determined by immunometric assays. RESULTS:All patients and controls showed significant circadian TSH rhythms, but the percentage amplitude was decreased (7.5% vs. 21.3%, P < 0.0001) and the acrophase was markedly displaced in SS patients, occurring between 0315 h and 1515 h in seven/nine patients and in two/nine controls (P = 0.057). Patients showed increased total 24-h TSH secretion (6054 +/- 2293 vs. 2193 +/- 340 mU/l/min, mean +/- SE, P = 0.04) due to increased non-pulsatile or tonic 24-h TSH secretion (5631 +/- 2105 vs. 1925 +/- 301 mU/l/min, P = 0.026), but no difference was detected in pulsatile secretion (424 +/- 191 vs. 268 +/- 41, P = 0.82). The contribution of non-pulsatile to total TSH secretion was also increased in SS patients (93.8% vs. 87.6%, P = 0. 002). No significant changes were found in TSH pulse frequency, amplitude, duration or interpeak interval. When cluster parameters were individually analysed in two distinctive 12-h periods corresponding to acrophase and nadir, patients showed increased non-pulsatile TSH secretion in both periods, but no differences were found in pulsatile TSH secretion, pulse frequency or amplitude. The increment of TSH secretion during the acrophase in SS patients was exclusively due to increased non-pulsatile TSH secretion, as opposed to controls who displayed significant increments in both non-pulsatile and pulsatile TSH secretions. CONCLUSIONS:Sheehan's syndrome patients have increased total TSH secretion due to increased tonic TSH secretion. A circadian TSH rhythm is still present in these patients, but shows decreased magnitude and markedly displaced acrophase.
journal_name
Clin Endocrinol (Oxf)journal_title
Clinical endocrinologyauthors
MacCagnan P,Oliveira JH,Castro V,Abucham Jdoi
10.1046/j.1365-2265.1999.00808.xkeywords:
subject
Has Abstractpub_date
1999-10-01 00:00:00pages
439-47issue
4eissn
0300-0664issn
1365-2265pii
cen808journal_volume
51pub_type
杂志文章abstract:OBJECTIVE:Nonuniformity in suppression of spermatogenesis induced by various hormones or hormone combinations has impeded the development of an effective hormonal male contraceptive. The basis for this heterogeneity in response remained unresolved to date; however, the presence of ethnic differences points to an involv...
journal_title:Clinical endocrinology
pub_type: 杂志文章
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journal_title:Clinical endocrinology
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doi:10.1111/j.1365-2265.1982.tb00725.x
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journal_title:Clinical endocrinology
pub_type: 临床试验,杂志文章,随机对照试验
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doi:10.1046/j.1365-2265.1999.00759.x
更新日期:1999-08-01 00:00:00
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更新日期:1997-09-01 00:00:00
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doi:10.1111/j.1365-2265.2008.03507.x
更新日期:2009-09-01 00:00:00
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journal_title:Clinical endocrinology
pub_type: 杂志文章
doi:10.1111/j.1365-2265.1988.tb03854.x
更新日期:1988-06-01 00:00:00
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更新日期:2014-03-01 00:00:00
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更新日期:2009-01-01 00:00:00
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journal_title:Clinical endocrinology
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doi:10.1111/j.1365-2265.1993.tb02378.x
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更新日期:2001-12-01 00:00:00
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更新日期:2018-01-01 00:00:00
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journal_title:Clinical endocrinology
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1984-03-01 00:00:00
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更新日期:2017-02-01 00:00:00
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更新日期:2005-02-01 00:00:00
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journal_title:Clinical endocrinology
pub_type: 杂志文章,评审
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更新日期:1988-12-01 00:00:00
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更新日期:2013-02-01 00:00:00
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journal_title:Clinical endocrinology
pub_type: 杂志文章
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更新日期:2019-04-01 00:00:00
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journal_title:Clinical endocrinology
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更新日期:1980-12-01 00:00:00