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COMBINED PITUITARY FUNCTION TESTS BY SIMULTANEOUS INJECTION OF SEVERAL RELEASING HORMONES

With the discovery of hpGRF and hCRF pituitary function can be assessed by the use of four physiologic releasing hormones.After a rest of two hours to reach basal cortisol levels, healthy young male volunteers received a bolus of the following releasing hormones: 1) GRF (100 μg) + CRF (50 μg) + TRH (200 μg) + LHRH (100μg) 2) GRF + TRH 3) CRF + TRH 4) LHRH + TRH 5) each releasing hormone alone (n=5 in each group). During the following two hours, GH, ACTH, cortisol, TSH, LH, FSH and prolactin were measured every fifteen minutes. The combination of the four releasing hormones resulted in a rapid rise of all measured hormones with the following peak values: GH: 20,6 ± 3.8 ng/ml, ACTH: 81 ± 7 pg/ml, cortisol: 112 ± 8 ng/ml, TSH: 17.6 ± 2.2 μU/ml, LH: 143 ± 25 ng/ml, FSH: 582 ± 132 ng/ml and prolactin: 39 ± 7 ng/ml (x ± SEM). The peak level of TSH in the combined test was nearly twice the level in single TRH-tests (TSH max: 10,2 ± 1,3 μU/ml, Students’ t-test, p < 0.05). Exaggerated TSH-response to TRH was shown to be entirely due to additional GRF administration, CRF in combination with TRH had no additional effect on TSH release. For all other measured hormones we found no significant differences between application of a single releasing hormone and the combinations studied (analysis of variance). We conclude that: 1) The combined injection of four releasing hormones provides a valuable test for anterior pituitary function. As there are practically no side effects, application in children is favored. 2) In this test increased TSH-response is to be considered.