Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Although the effect of inhaled corticosteroids (ICS) on the hypothalamic- pituitary-adrenal axis (HPA) has been regarded as a “benign physiological response”, a survey published in 2002 suggested that adrenal crisis is more common in asthmatic children on ICS than previously thought. Relying on clinical features to detect chronic adrenal insufficiency secondary to corticosteroids may not be wise, as these are non-specific and can therefore easily be missed. Accurate biochemical assessment of the whole axis to detect subclinical HPA suppression (HPAS) is thus desirable. A review of the literature indicates that basal adrenal function tests, including plasma cortisol profiles, do not identify which children can appropriately respond to stress. There is no evidence to suggest that the degree of the physiological adjustment of the HPA to ICS and/or nasal steroids (by reducing basal cortisol production), predicts HPAS. Cortisol profiles should therefore only be used to demonstrate differences in systemic activity of various ICS and delivery devices. Only two tests, considered as gold standard adrenal function tests [the insulin tolerance test (ITT) and the metyrapone test] can assess the integrity of the whole axis. / AFRIKAANSE OPSOMMING: Die outeurs van ´n opname wat in 2002 gepubliseer is stel voor dat ´n bynierkrisis meer algemeen by asmatiese kinders, wat inhalasie kortikosteroïede ontvang, voorkom as wat voorheen gedink is. Dit is strydig met die gevestigde opvatting dat die effek van IKS op die hipotalamiese-hipofise-bynier-as (HHB) ’n “goedaardige fisiologiese reaksie” is. Die kliniese kenmerke van kroniese bynierontoereikendheid sekondêr tot die gebruik van kortikosteroïede (KS) is nie-spesifiek en gevolglik onbetroubaar. ´n Akkurate biochemiese toets van subkliniese HBB onderdrukking (HHBO) sou gevolglik waardevol wees. ´n Literatuur oorsig toon dat toetse van basale bynierfunksie, insluitend plasma kortisol (K) profiele, nie kinders uitken wat toepaslik op stres sal reageer nie. Daar is geen bewyse dat die graad van fisiologiese aanpassing van die HHB, soos aangedui deur laer K-vlakke, na die gebruik van IKS en/of nasale steroïede (NS), HHBO voorspel nie. Serum K profiele is dus slegs van waarde om die sistemiese aktiwiteit van verskillende IKS en toedieningsstelsels te ondersoek. Slegs twee toetse, naamlik die insulien toleransie toets (ITT) en die metyrapone -(MTP)-toets (wat beide as die goue standaard van bynier funksie beskou word), kan die integriteit van die hele as meet.

The Siberian hamster (Phodopus sungorus) undergoes a suite of physiological changes in response to short day (SD) photoperiod which includes a marked reduction in body mass (up to 40%). This altered physiology can be reversed by a return to long day (LD) photoperiod and is driven by changes hypothalamic gene expression. Additionally, stimulation of weight regain occurs through spontaneous exercise when hamsters are provided with a running wheel (RW), despite intact photoperiod appropriate hypothalamic gene expression. The foundation hypothesis for this investigation was that the change in body weight in both paradigms is underpinned by an alteration of the growth hormone (GH) axis. Pasireotide, a somatostatin agonist, was utilised to inhibit GH secretion from the pituitary in both paradigms. Measurement of body mass, mass of internal organs, body composition by magnetic resonance imaging, hormonal analysis and in situ hybridization were used to determine the effect of a blockade of GH secretion by pasireotide. Pasireotide suppressed the GH axis in Siberian hamsters; with reduced circulating insulin-like growth factor-1 and altered hypothalamic gene expression of somatostatin (srif) and growth hormone – releasing hormone (ghrh) consistent with an inhibition of pituitary GH secretion. Pasireotide treatment inhibited RW and LD stimulated growth, and when administered to LD hamsters caused weight loss in a similar manner to that which occurs in SD and accompanied by testicular atrophy. In addition, pasireotide increased the incidence of torpor and increased bout length of this hypometabolic state in sedentary SD hamsters. In conclusion, evidence is provided for the hypothalamic – pituitary – growth hormone axis in the determination of photoperiod and RW induced body weight changes. Furthermore, the data show evidence for a novel muscle – brain pathway and evidence for a neuroendocrine pathway involved in torpor induction.

published_or_final_version / Zoology / Master / Master of Philosophy

No description available.

No description available.

The hypothalamic peptide arginine vasopressin (AVP) is an important regulator of adrenocorticotropin (ACTH) release from the anterior pituitary. AVP stimulates ACTH secretion from corticotroph cells by activating the pituitary vasopressin receptor (V1b-R), a member of the G protein-coupled receptor (GPCR) family. In vitro, repeated stimulus of anterior pituitary cells with AVP results in rapid desensitisation. The aim of this research was to develop methods needed to use RNA interference (RNAi) to investigate the role of G protein-coupled receptor kinase 5 (GRK5) in this desensitisation process. This required the development of a model system using human embryonic kidney (HEK) 293 cells transfected with the pituitary vasopressin receptor, V1b-R. AVP binding to the V1bR activates the phosphoinositide signalling pathway, leading to production of inositol phosphates (IPs), which can be measured following radiolabelling of cells with myo-[³H]inositol. Stimulation of V1b-R-transfected cells for 15 min with AVP (100nM) increased IP production to 235.5 ± 23.4 % (n=3, p<0.02) of that seen in un-stimulated control cells. Following a 5 minute pre-treatment with 5nM VP, the IP response to stimulation with 100nM VP for 15 min was reduced to 62.8 ± 9.1 % (n=4, p<0.02) of that seen in control cells that were not pre-treated. These data indicate that AVP-desensitisation can be induced and measured in V1bR-transfected HEK293 cells following a brief pre-treatment with a physiological concentration of AVP. This model system will enable RNAi to be used to investigate the role of GRK5 in AVP-desensitisation. When using RNAi, it is essential to establish that the effects observed are the result of small interfering RNA (siRNA) specific degradation of the target mRNA. Quantitative reverse transcription PCR (qRT-PCR) was used to measure the expression of GRK5 at the mRNA level in HEK293 cells. Human GRK5 mRNA was amplified using qRT-PCR with GRK5 specific primers, providing confirmation that GRK5 is expressed endogenously in HEK293 cells. GRK5 expression studies were carried out to evaluate whether the qRT-PCR methods developed would be suitable to measure knockdown of GRK5 mRNA using RNAi. These experiments were also designed to assess the impact of HEK293 cell culture methods on expression of GRK5. Expression of GRK5 did not vary with passage number (2-26 passages). The GRK5 expression in HEK293 cells that were maintained in culture for 5 days (grown to a confluence of approximately 100%) was 7.4 ± 0.9 fold greater (n=2, p<0.05) than for cells cultured for 3 days (grown to a confluence of approximately 65%). These data indicate that GRK5 expression is affected by HEK293 culture conditions. Furthermore, the results demonstrated that a significant difference in GRK5 expression could be measured in HEK293 cells using qRT-PCR. Therefore the results reported in this thesis provide the basis for future studies utilising RNAi to investigate mechanisms underlying V1b-R desensitisation.

No description available.

Exactly where in the hypothalamus is the adrenal-pituitary response to X-irradiation "triggered" or initiated? Moreover, does ionizing radiation act directly on specific centers in the brain or does it act indirectly via the production of some humoral agents? Finally, what role does the hypothalamus play in the radiation-syndrome? The purpose of the present study was to attempt to answer these questions by determining the effects of two stressor agents, X-irradiation and electrical stimulation applied either singly or together, on the activity of the adrenal-pituitary axis. The parameters measured were changes in plasma corticosterone, in circulating eosinopihils, and in adrenal gland weight.

Pituitary adenomas constitute about 15% of intracranial tumors, and about one-third of secretory pituitary adenomas produce ACTH. Corticotroph adenomas, a subset of pituitary adenomas staining positive for ACTH, are further categorized into functional (FCA) and silent (SCA) adenomas. FCAs result in central Cushing’s disease (CD) due to the resulting excess of cortisol secretion stimulated by ACTH secretion through hormone disruption while SCAs exhibit mass effects and show increased aggression as compared to its functional counterpart. Obesity and cardiovascular disease, resulting from hypercortisolism in functional adenomas, increase patient morbidity while the invasive nature of silent adenomas increases mortality. Trans sphenoidal surgery (TSS) is the best available treatment option for cotricotroph adenomas, but tumor recurrence is common. We sought to identify differential genetic drivers of sporadic FCAs and SCAs in order to better characterize these tumors and develop novel treatment options. We examined 17 adenomas including 12 FCA and 5 SCA as well as 2 corticotroph hyperplasia (CH) tissue samples. We performed next generation sequencing using OncoPanel versions 2 and 3 on patients operated on at Brigham and Woman’s Hospital between 2008 and 2018 and determined to have a corticotroph adenoma. 3 of 4 FCA patients screened for USP8 mutations contained variants previously described in CD including USP8S718P and USP8S719del. 3 of the 12 FCA patients screened for mutations in ARID1B contained novel variants and 1 patient contained a variant previously described in large intestine adenocarcinomas. Additionally, SNPs were commonly identified in genes responsible for epigenetic regulation implicating histone modification as a therapeutic target. We identified recurrent copy number variants (CNV) in both FCAs and SCAs. Gains of 6p, 20q and 21q were frequently observed in FCAs alongside less common losses in 11p and 19q. Significant amplifications of chromosome 12 were detected in SCAs with single nucleotide deletions in chromosome 10. Furthermore, we report diverging genomic disruption between subtypes associated with functional hormone status. Our data identifies novel genetic drivers in subclasses of corticotroph adenomas and indicate distinct genomic profiles associated with hormone secretion and clinical presentation. Further research is required to better elucidate the role of these genetic variants and how they influence tumorigenesis and hormone production.

INTRODUÇÃO: O hipopituitarismo está associado, em cerca de 40% dos casos, à ectopia da neuro-hipófise observada em imagem por ressonância magnética (RM). Nestes pacientes a visualização da haste ocorre predominantemente nos que têm deficiência isolada de GH (DIGH), enquanto a não visualização da mesma está mais associada à deficiência hipofisária múltipla (DHM). A etiologia deste quadro, no entanto, permanece indeterminada na maioria dos pacientes. A elevada freqüência de parto pélvico e de complicações neonatais sugere uma causa traumática, enquanto que relatos de casos familiares, associação com outras patologias do SNC e descrição de mutações nos genes HESX1, LHX4 e SOX3 apontam para uma causa genética. O LHX4 é um fator de transcrição envolvido na embriogênese hipofisária fundamental para a formação da bolsa de Rathke definitiva. O LHX4 está localizado no cromossomo 1q 25, possui 6 éxons e estende-se por mais de 45 kb de DNA genômico. A única mutação publicada neste gene em humanos é a IVS4-1G>C, associada a um fenótipo caracterizado por baixa estatura, deficiências de GH, TSH e ACTH, neuro-hipófise ectópica e malformação Arnold-Chiari tipo I. O objetivo do estudo é analisar as regiões exônicas e éxon-íntron do LHX4 e caracterizar o perfil hormonal, correlacionando com os achados de RM, em 63 pacientes com hipopituitarismo associado a neurohipófise ectópica. MÉTODOS: Os pacientes foram submetidos à avaliação hormonal e por imagem através de ressonância magnética. A análise molecular incluiu amplificação do gene por PCR, seqüenciamento automático e uso de enzima de restrição. RESULTADOS: A visualização da haste ocorreu em 21 pacientes; destes, 10 (48%) apresentaram DIGH. A não visualização da haste foi mais associada a DHM, o que ocorreu em 40 (95%) dos 42 pacientes. Não encontramos diferença significativa quando comparamos pacientes com haste visualizada e não visualizada quanto à freqüência de partos vaginais em apresentação pélvica, à freqüência de malformações do SNC e à posição precisa da neuro-hipófise ectópica. Identificamos 6 variações alélicas no gene LHX4 em nossos pacientes: GGT>GGC, no códon 21; GAC>GAT, no códon 128; AAC>AAT, no códon 150; AGC>AGT, no códon 230; GGA>GGT, no códon 283 e AAT>AGT no códon 329 (N329S), esta já descrita como polimorfismo no GenBank. Nenhuma das outras variações determina troca de aminoácidos, altera o sítio de \"splice\" ou se correlaciona com um padrão de deficiência hormonal característico. As variações alélicas nos códons 21, 128 e 150 foram caracterizadas como polimorfismos. Não foi possível estabelecer uma relação entre as variações alélicas e o fenótipo dos pacientes. CONCLUSÃO: Mutações no LHX4 são causas raras de hipopituitarismo / INTRODUCTION: Ectopic posterior pituitary lobe (EPL) is observed using magnetic resonance imaging (MRI) scans in about 40% of patients with hypopituitarism. In these patients, the pituitary stalk is visualized mainly in patients with isolated GH deficiency (IGHD), whilst it is not visualized predominantly in patients with combined pituitary hormone deficiency (CPHD). Nevertheless, the etiology of EPL remains undetermined in most of the patients. A traumatic etiology is proposed for this figure, which presents a high frequency of breech delivery and perinatal damages. On the other hand, a genetic cause is suggested by associations to other CNS abnormalities and reports of gene mutations in HESX1, LHX4 and SOX3, as well as familial cases. LHX4 is a transcription factor implicated in pituitary embryogenesis which is essential to definitive Rathke\'s pouch development. It is located in chromosome 1q25, has 6 exons and is stretched out for more than 45 kb of genomic DNA. The only documented human mutation in this gene, IVS4-1G>C, is associated to a phenotype characterized by short stature, GH, TSH and ACTH deficiencies, EPL and Arnold-Chiari type I malformation. The aim of this study is to analyze exonic and exon-intron regions of LHX4 gene and characterize the hormonal deficiency profiles, establishing relationships to MRI findings in 63 patients with hypopituitarism associated to EPL. METHODS: All patients were submitted to hormonal evaluation and MRI scans. The molecular analysis included amplification of the gene using PCR, direct automatic sequencer and digestion with restriction enzymes. RESULTS: The pituitary stalk was visualized in 21 patients; of these, 10 (48%) exhibited IGHD. The stalk was not visualized in 42 patients, most of them with CPHD (95%). We did not find a statistical difference, when patients with and without visualized pituitary stalk were compared, regarding breech deliveries, CNS malformations and exact position of EPL. We identified 6 allelic variations in LHX4 gene: GGT>GGC in codon 21, GAC>GAT in codon 128, AAC>AAT in codon 150, AGC>AGT in codon 230, GGA>GGT in codon 283 and AAT>AGT in codon 329 (N329S), this already related as a polymorphism in GenBank. None of the former variations determine amino acid changes, nor splicing site changes, not even are related to a typical profile of hormonal deficiency. The allelic variations in codons 21, 128 and 150 were described as polymorphisms. It was not possible to establish a relationship between the allelic variations and the phenotype. CONCLUSION: LHX4 gene mutations are rare causes of hypopituitarism