Summary
A factor is present in the plasma which “binds” ACTH thus disturbing the radioimmunologic system. Therefore, ACTH was extracted for radioimmunological measurement. A simple method is described to extract a representative part of the ACTH from plasma utilizing the high capacity of silicates (QUSO G-32) to adsorb free, intact ACTH.
Basal values of QUSO-extractable, immunoassayable ACTH in normal persons at 8 a.m. amounted from 0 to 120 pg/ml (\(\bar x\)=30.3 pg/ml). In most patients with Cushing's disease basal values were clearly elevated. The highest ACTH levels (up to 6000 pg/ml) were found in untreated Addison's disease. Under normal clinical conditions there were marked fluctuations of the ACTH level during 24 hours in normal persons as well as in patients with Cushing's disease. However, a peak value during the early morning hours was not constantly recovered. Lysin-vasopressin infusion (5 I.U. LVP/60 min) induced a rapid increase in ACTH concentrations, which began to fall after the 30th minute while infusion of LVP continued. The rise in plasma ACTH following oral administration of metyrapone (750 mg every 4 hours during 24 hours) was delayed for about 12 hours from the first administration and elevated levels were demonstrable up to 12 hours after the last administration. There were remarkable differences in the temporal pattern of the ACTH levels after administration of metyrapone.
Zusammenfassung
Ein in Plasma vorhandener Faktor „bindet“ ACTH und stört so das radioimmunologische System. Deswegen wurde ACTH zur radioimmunologischen Messung extrahiert. Eine einfache Methode zur Extraktion eines representativen Teils des Plasma-ACTH wird beschrieben, die die hohe Kapazität von Silicaten (QUSO-G32) nützt, freies, intaktes ACTH zu adsorbieren.
Die basalen Werte des QUSO extrahierbaren, immunologisch meßbaren ACTH bei Normalpersonen um 800 lagen zwischen 0 und 120 pg/ml (\(\bar x\)=30,3 pg/ml). Bei den meisten Patienten mit Morbus Cushing waren die Basalwerte eindeutig erhöht. Die höchsten ACTH-Spiegel (bis 6000 pg/ml) wurden beim unbehandelten Morbus Addison gefunden. Unter den üblichen Klinikbedingungen fanden sich erhebliche Fluktuationen des ACTH-Spiegels während 24 Std bei Normalpersonen ebenso wie bei Patienten mit Morbus Cushing. Ein Gipfel während der frühen Morgenstunden wurde jedoch nicht regelmäßig beobachtet. Die Lysin-Vasopressin-Infusion (5 I.U. LVP/60 min) führte zu einem raschen Anstieg der ACTH-Konzentration, die nach der 30. min wieder abfiel, obwohl die Infusion von LVP anhielt. Der Anstieg des Plasma-ACTH nach oraler Gabe von Metopiron (750 mg alle 4 Std über 24 Std) trat mit einer Verzögerung von 12 Std nach der 1. Metopirongabe auf; erhöhte Spiegel konnten noch 12 Std nach der letzten Gabe gefunden werden. Das zeitliche Verhalten der ACTH-Spiegel nach Gabe von Metopiron zeigte erhebliche Unterschiede.
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Supported by Deutsche Forschungsgemeinschaft, Bad Godesberg SFB 87/Endokrinologie Ulm.
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Voigt, K.H., Fehm, H.L., Reck, R. et al. Spontaneous and stimulated secretion of QUSO-extractable immunoassayable ACTH in man. Klin Wochenschr 52, 516–521 (1974). https://doi.org/10.1007/BF01468721
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DOI: https://doi.org/10.1007/BF01468721