Skip to main content
NCBI home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1973 May;52(5):1099–1107. doi: 10.1172/JCI107275

Assessment of Thyrotropin-Releasing Hormone and Thyrotropin Reserve in Man

Peter A Singer 1, John T Nicoloff 1
PMCID: PMC302364  PMID: 4633675

Abstract

Endogenous thyrotropin-releasing hormone (TRH) reserve and pituitary thyrotropin (TSH) reserve were assessed in four normal subjects, three patients post-cryohypophysectomy, one patient with a hypothalamic lesion secondary to trauma, and four patients with Sheehan's syndrome. TSH reserve was determined by the immunoassayable TSH response to 500 μg TRH given i.v. (TRH stimulation test). TRH reserve was assessed by the rebound response in thyroidal iodine release (TIR) following withdrawal of pharmacologic doses of prednisolone (glucocorticoid withdrawal test). When compared with normals, the post-cryohypophysectomy patients demonstrated parallel impairment of TRH stimulation and glucocorticoid withdrawal testing. The patient with the hypothalamic lesion and the four patients with Sheehan's syndrome all had normal TRH stimulation tests, indicating adequate TSH reserve capacity, yet had abnormal glucocorticoid withdrawal tests, indicative of impairment in endogenous TRH reserve or neurohumoral transport. Three of the patients (hypothalamic injury and two Sheehan's) with impaired TRH reserve were euthyroid.

The following conclusions were reached: (a) A combination of the TRH stimulation test and glucocorticoid withdrawal test may allow for differentiation between pituitary and suprahypophyseal disorders. (b) Certain cases of Sheehan's syndrome appear to have impaired endogenous TRH reserve or transport. (c) Euthyroidism can be maintained in spite of diminished TRH reserve.

Full text

PDF
1099

Images in this article

1102Image
on p.1102
1103Image
on p.1103
1104Image
on p.1104
1104Image
on p.1104
1105Image
on p.1105

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Costom B. H., Grumbach M. M., Kaplan S. L. Effect of thyrotropin-releasing factor on serum thyroid-stimulating hormone. An approach to distinguishing hypothalamic from pituitary forms of idiopathic hypopituitary dwarfism. J Clin Invest. 1971 Oct;50(10):2219–2225. doi: 10.1172/JCI106717. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Fleischer N., Lorente M., Kirkland J., Kirkland R., Clayton G., Calderon M. Synthetic thyrotropin releasing factor as a test of pituitary thyrotropin reserve. J Clin Endocrinol Metab. 1972 Apr;34(4):617–624. doi: 10.1210/jcem-34-4-617. [DOI] [PubMed] [Google Scholar]
  3. GREENWOOD F. C., HUNTER W. M., GLOVER J. S. THE PREPARATION OF I-131-LABELLED HUMAN GROWTH HORMONE OF HIGH SPECIFIC RADIOACTIVITY. Biochem J. 1963 Oct;89:114–123. doi: 10.1042/bj0890114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Greenwood F. C., Landon J., Stamp T. C. The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin. I. In control subjects. J Clin Invest. 1966 Apr;45(4):429–436. doi: 10.1172/JCI105357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Gross H. A., Appleman M. D., Jr, Nicoloff J. T. Effect of biologically active steroids on thyroid function in man. J Clin Endocrinol Metab. 1971 Aug;33(2):242–248. doi: 10.1210/jcem-33-2-242. [DOI] [PubMed] [Google Scholar]
  6. Haigler E. D., Jr, Pittman J. A., Jr, Hershman J. M., Baugh C. M. Direct evaluation of pituitary thyrotopin reserve utilizing synthetic thyrotopin releasing hormone. J Clin Endocrinol Metab. 1971 Oct;33(4):573–581. doi: 10.1210/jcem-33-4-573. [DOI] [PubMed] [Google Scholar]
  7. Hershman J. M., Pittman J. A., Jr Response to synthetic thyrotropin-releasing hormone in man. J Clin Endocrinol Metab. 1970 Oct;31(4):457–460. doi: 10.1210/jcem-31-4-457. [DOI] [PubMed] [Google Scholar]
  8. Jackson I. M., Whyte W. G., Garrey M. M. Pituitary function following uncomplicated pregnancy in Sheehan's syndrome. J Clin Endocrinol Metab. 1969 Mar;29(3):315–318. doi: 10.1210/jcem-29-3-315. [DOI] [PubMed] [Google Scholar]
  9. Lawton N. F., Ekins R. P., Nabarro J. D. Failure of pituitary response to thyrotrophin-releasing hormone in euthyroid Graves' disease. Lancet. 1971 Jul 3;2(7714):14–16. doi: 10.1016/s0140-6736(71)90006-7. [DOI] [PubMed] [Google Scholar]
  10. MURPHY B. E., PATTEE C. J. DETERMINATION OF THYROXINE UTILIZING THE PROPERTY OF PROTEIN-BINDING. J Clin Endocrinol Metab. 1964 Feb;24:187–196. doi: 10.1210/jcem-24-2-187. [DOI] [PubMed] [Google Scholar]
  11. Martin J. E., MacDonald P. C., Kaplan N. M. Successful pregnancy in a patient with Sheehan's syndrome. N Engl J Med. 1970 Feb 19;282(8):425–427. doi: 10.1056/NEJM197002192820805. [DOI] [PubMed] [Google Scholar]
  12. Nicoloff J. T. A new method for the measurement of acute alterations in thyroxine deiodination rate in man. J Clin Invest. 1970 Feb;49(2):267–273. doi: 10.1172/JCI106236. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nicoloff J. T. A new method for the measurement of thyroidal iodine release in man. J Clin Invest. 1970 Oct;49(10):1912–1921. doi: 10.1172/JCI106410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Nicoloff J. T., Fisher D. A., Appleman M. D., Jr The role of glucocorticoids in the regulation of thyroid function in man. J Clin Invest. 1970 Oct;49(10):1922–1929. doi: 10.1172/JCI106411. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Odell W. D., Wilber J. F., Utiger R. D. Studies of thyrotropin physiology by means of radioimmunoassay. Recent Prog Horm Res. 1967;23:47–85. doi: 10.1016/b978-1-4831-9826-2.50005-2. [DOI] [PubMed] [Google Scholar]
  16. Ormston B. J., Cryer R. J., Garry R., Besser G. M., Hall R. Thyrotrophin-releasing hormone as a thyroid-function test. Lancet. 1971 Jul 3;2(7714):10–14. doi: 10.1016/s0140-6736(71)90005-5. [DOI] [PubMed] [Google Scholar]
  17. Pittman J. A., Jr, Haigler E. D., Jr, Hershman J. M., Pittman C. S. Hypothalamic hypothyroidism. N Engl J Med. 1971 Oct 7;285(15):844–845. doi: 10.1056/NEJM197110072851508. [DOI] [PubMed] [Google Scholar]
  18. RUTHERFORD E. R., NELSON D. H. Determination of urinary 17-ketogenic steroids by means of sodium metaperiodate oxidation. J Clin Endocrinol Metab. 1963 Jun;23:533–538. doi: 10.1210/jcem-23-6-533. [DOI] [PubMed] [Google Scholar]
  19. SHEEHAN H. L. THE REPAIR OF POST-PARTUM NECROSIS OF THE ANTERIOR LOBE OF THE PITUITARY GLAND. Acta Endocrinol (Copenh) 1965 Jan;48:40–60. doi: 10.1530/acta.0.0480040. [DOI] [PubMed] [Google Scholar]
  20. Snyder P. J., Utiger R. D. Response to thyrotropin releasing hormone (TRH) in normal man. J Clin Endocrinol Metab. 1972 Feb;34(2):380–385. doi: 10.1210/jcem-34-2-380. [DOI] [PubMed] [Google Scholar]
  21. Sterling K., Brenner M. A. Free thyroxine in human serum: simplified measurement with the aid of magnesium precipitation. J Clin Invest. 1966 Jan;45(1):153–163. doi: 10.1172/JCI105320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Wilber J. F., Utiger R. D. The effect of glucocorticoids on thyrotropin secretion. J Clin Invest. 1969 Nov;48(11):2096–2103. doi: 10.1172/JCI106176. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES