Interleukin-4 increases cortisol release and decreases adrenal androgen release from bovine adrenal cells

ACTH is the primary regulator of adrenal function during acute stress. However, during chronic inflammatory stress additional factors play a major role in the regulation of adrenal secretion. Many cytokines circulate in the blood and are synthesized and released from adrenal tissue. Furthermore, these peptides modify adrenal function. Recently, interleukin-4 (IL-4) was demonstrated to be released from a human adrenal tumor cell line. Therefore, we hypothesized that normal bovine adrenocortical cells could express IL-4 and that this cytokine may modify adrenal function. We determined that IL-4 and IL-4 receptors (IL-4R) are expressed in the bovine adrenal cortex whereas the expression of IL-4 and IL-4R in the adrenal medulla was not apparent. Exposure of dispersed bovine adrenocortical cells isolated from the zona fasciculate to IL-4 did not modify basal release of cortisol. However, the ACTH-stimulated release of cortisol from the bovine adrenal cells was augmented by IL-4. IL-4 exposure had no affect on adrenal androgen release from bovine zona reticularis cells, but IL-4 inhibited the ACTH-stimulated release of adrenal androgens from these cells. The effects of IL-4 on ACTH-stimulated cortisol and adrenal androgen release were dependent upon the IL-4 incubation interval and the IL-4 concentration. Because communication between the immune and endocrine systems is important in inflammatory conditions, IL-4 may play a role in coordinating the adrenal response to inflammatory stress.     

Pituitary ACTH and adrenocortical secretion in critically ill dogs

OBJECTIVE: To evaluate pituitary-adrenal function in a population of critically ill dogs by measuring serial plasma concentrations of basal cortisol, ACTH-stimulated cortisol, and endogenous ACTH. DESIGN: Prospective study. ANIMALS: 20 critically ill dogs admitted to an intensive care unit (ICU). PROCEDURE: Basal plasma cortisol, ACTH-stimulated cortisol, and endogenous ACTH concentrations were measured for each dog within 24 hours of admission and daily until death, euthanasia, or discharge from the ICU. Established reference ranges for healthy dogs were used for comparison. Survival prediction index (SPI) scores were calculated for each dog within 24 hours of admission. RESULTS: No significant difference was found between initial concentrations of basal cortisol, ACTH-stimulated cortisol, and endogenous ACTH in 13 dogs that survived and those in 7 dogs that died. High initial basal endogenous ACTH concentrations were correlated with subsequent high values. Low basal ACTH-stimulated cortisol concentrations were predictive of higher subsequent values. All basal and ACTH-stimulated cortisol concentrations were within or above the reference range in the 52 plasma samples collected from the 20 dogs during hospitalization. The SPI scores correlated with outcome (ie, alive or dead), but none of the plasma hormone concentrations correlated with SPI score or outcome. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate that none of the critically ill dogs in our study population developed adrenal insufficiency during hospitalization in the ICU.     

Adrenal response to the low dose ACTH stimulation test and the cortisol-to-adrenocorticotrophic hormone ratio in canine babesiosis

This prospective, interventional, case-controlled study sought to determine the association between adrenocortical function and mortality in dogs with naturally occurring Babesia rossi babesiosis. Sixty-eight dogs with canine babesiosis were studied and fifteen normal dogs were used as controls. Blood samples were obtained from the jugular vein in each dog prior to treatment, at admission to hospital, for the measurement of basal plasma ACTH (adrenocorticotrophic hormone) and serum cortisol concentrations. Immediately thereafter, each dog was injected intravenously with 5 microg/kg of ACTH (tetracosactrin). A second blood sample was taken 1h later for serum ACTH-stimulated cortisol measurement and the resultant calculation of delta cortisol by subtracting basal from ACTH-stimulated cortisol. Diagnosis of babesiosis was confirmed by polymerase chain reaction (PCR) and reverse line blot (RLB). Three outcomes were defined: hospitalization with subsequent death (n=4); hospitalization followed by recovery (n=48); and treatment as an outpatient (n=16). Basal cortisol, but not ACTH-stimulated cortisol, was significantly higher in patients compared to control dogs. Basal- and ACTH-stimulated serum cortisol concentrations were significantly higher in the dogs that died, compared to hospitalized dogs that survived and compared to dogs treated as outpatients. There was no significant difference in delta cortisol concentrations or cortisol to ACTH ratios across outcome groups in dogs suffering from B. rossi babesiosis However, dogs with delta cortisol concentrations below 83 nmol/l had significantly higher cortisol to ACTH ratios compared to dogs with delta cortisol concentrations above 83 nmol/l. These findings of increased basal- and ACTH-stimulated cortisol and increased cortisol to ACTH ratios confirm the absence of adrenal insufficiency and concur with those in human malaria.     

Adrenocorticotropic hormone-induced secretion of cortisol in goats is inhibited by androgen

In a previous study, it was found that there are sex differences in goats with respect to the levels of cortisol secretion induced by transportation stress. We also found that treatment of castrated male goats with dihydrotestosterone (DHT) suppressed the increase in plasma cortisol concentration following transportation, but did not suppress the secretion of adrenocorticotropic hormone (ACTH). This suggests that androgen might block ACTH ‐ induced cortisol secretion. In order to examine this hypothesis, the effects of androgen on ACTH‐induced cortisol secretion in goats were investigated. First, castrated male goats were treated with testosterone (T), DHT or cholesterol (cho) for 21–25 days. Cho was used as a control for T and DHT treatment. Then, plasma cortisol concentrations were compared among the hormonal treatments after ACTH injection. Subsequently, the distribution of androgen receptors in the caprine adrenal gland was investigated. There were no differences in the basal cortisol concentrations among the hormonal treatments. However, plasma cortisol concentrations after ACTH injection were significantly lower in T ‐ and DHT ‐ treated goats than in cho ‐ treated goats. Androgen receptors were present in 60% of the cells in the zonae fasciculata and reticularis of the adrenal cortex, the regions that secrete glucocorticoids. These results suggest that androgen may act directly on the adrenal cortex to suppress cortisol secretion induced by ACTH.     

Expression of leukemia inhibitory factor and leukemia inhibitory factor receptor in the canine pituitary gland and corticotrope adenomas

Leukemia inhibitory factor (LIF) is a pleiotropic cytokine of the IL-6 family that activates the hypothalamic-pituitary-adrenal axis and promotes corticotrope cell differentiation during development. The aim of this study was to investigate the expression of LIF and its receptor (LIFR) in the canine pituitary gland and in corticotrope adenomas, and to perform a mutation analysis of LIFR. Using immunohistochemistry, immunofluorescence, and quantitative expression analysis, LIF and LIFR expression were studied in pituitary glands of control dogs and in specimens of corticotrope adenoma tissue collected through hypophysectomy in dogs with pituitary-dependent hypercortisolism (PDH, Cushing's disease). Using sequence analysis, cDNA was screened for mutations in the LIFR. In the control pituitary tissues and corticotrope adenomas, there was a low magnitude of LIF expression. The LIFR, however, was highly expressed and co-localized with ACTH_1-24 expression. Cytoplasmatic immunoreactivity of LIFR was preserved in corticotrope adenomas and adjacent nontumorous cells of pars intermedia. No mutation was found on mutation analysis of the complete LIFR cDNA. Surprisingly, nuclear to perinuclear immunoreactivity for LIFR was present in nontumorous pituitary cells of the pars distalis in 10 of 12 tissue specimens from PDH dogs. These data show that LIFR is highly co-expressed with adrenocorticotropic hormone (ACTH) and α-melanocyte-stimulating hormone (α-MSH) in the canine pituitary gland and in corticotrope adenomas. Nuclear immunoreactivity for LIFR in nontumorous cells of the pars distalis may indicate the presence of a corticotrope adenoma.     

Chronic effects of recombinant porcine growth hormone on adrenal weight and activity in pigs

This study was conducted to examine serum cortisol concentrations and adrenal cortisol output in pigs treated chronically with recombinant pGH (rpGH) at a maximally effective anabolic dose. Recombinant pGH (140 micrograms/kg body weight) was administered daily to eight barrows for 77 d. At slaughter, adrenal glands were removed, weighed and sliced; slices of fresh adrenal tissue were incubated for 1 h in the presence or absence of ACTH. Recombinant pGH increased adrenal weight by 39%. This change was accompanied by an inversely proportional reduction of in vitro cortisol output per gram of tissue, with the net result that total cortisol output per adrenal per kilogram of BW was unaltered, as was cortisol output in the presence of ACTH. Serum cortisol concentrations were measured in 10 barrows fitted with femoral artery catheters and treated daily with 0 or 140 micrograms rpGH/kg BW for 8 d. Basal and ACTH-stimulated cortisol concentrations were not altered by rpGH treatment. These results do not support our earlier speculation that a pGH-dependent increase in adrenal weight is associated with a chronic increase in adrenal activity, but rather demonstrate that corticosteroid output is tightly regulated and remains constant despite a marked increase in the size of the adrenal glands.     

白血病抑制因子及其受体在月经周期猕猴输卵管内的表达

应用免疫细胞化学方法对白血病抑制因子(LIF)、白血病抑制因子受体(LIFR)和gp130在月经周期猕猴输卵管内的表达进行了研究。结果表明，LIF、LIFR和gp130主要在输卵管上皮细胞内表达，而在固有层、肌层及泉膜内的表达量较少。LIF、LIFR和gp130在猕猴输卵管内的表达量随月经周期的不同而变化，在增殖中期到分泌中期的输卵管内表达量较高，而在增殖早期及分泌晚期输卵管内表达量较低。LIF及其受体在猕猴输卵管内的表达可能由卵巢分泌的类固醇激素所调控，LIF可能在猕猴排卵及早期胚胎发育过程中起重要的调节作用。     

Evaluation of adrenal function in psittacine birds, using the ACTH stimulation test

The effect of ACTH (16 units) on plasma cortisol and corticosterone concentrations in healthy psittacine birds was evaluated. Plasma corticosterone significantly increased (P less than 0.01) from a mean (+/- SD) basal concentration of 3.25 +/ 3.6 ng/ml to 26.47 +/- 9.25 (one hour after ACTH administration) and 25.69 +/- 13.23 ng/ml (2 hours after ACTH administration). For maximal increase in plasma corticosterone as measured by radioimmunoassay (RIA), heat denaturation was necessary to release corticosteroids from steroid-binding proteins. As measured by RIA, plasma cortisol concentrations did not increase, whether or not the heat denaturation step was included. Addition of cortisol to avian plasma did not prevent accurate quantification of cortisol as measured by RIA. Plasma corticosterone concentrations in cockatoos, macaws, Amazon parrots, conures, and lorikeets before and after ACTH administration indicated that the ACTH stimulation test could be used to evaluate adrenal secretory capacity in psittacine birds.     

冷应激大鼠肾上腺组织形态结构变化的研究

以大鼠为试验对象，研究冷应激情况下肾上腺组织结构的变化。结果表明：应激后大鼠肾上腺皮质束状带和网状带宽度显著增高．且分界明显。应激后束状带和髓质细胞数目显著高于常温对照组。球状带细胞数目增多．出现分裂情况；束状带细胞有脱颗粒现象，使细胞呈空泡状；网状带细胞胞质内脂质颗粒少，细胞小；髓质细胞体积增大，胞核大且密集，胞浆染色深。     

Pituitary–adrenal axis function in dogs with neoplasia*

Adrenocorticotropic hormone (ACTH) stimulation tests were done in healthy and tumour‐bearing dogs. In the tumour‐bearing dogs, plasma endogenous ACTH (eACTH) concentration was measured and adrenal gland size was assessed ultrasonographically. Measurements in the tumour‐bearing dogs were taken prior to therapy. No difference existed in basal or ACTH‐stimulated cortisol concentration between tumour‐bearing and healthy dogs. No difference existed in eACTH concentration between dogs with non‐haematopoietic neoplasia (NHN) and lymphoma. However, of 20 dogs with lymphoma, 15% had increased basal serum cortisol concentration, 5% had an exaggerated response to ACTH and 5% had an increased eACTH concentration. Of 15 dogs with NHN, 20% had increased basal cortisol concentration, 7% had an exaggerated ACTH response and no dogs had an increased eACTH concentration. Of the dogs with lymphoma and NHN, 5 and 13%, respectively, had decreased basal cortisol concentrations; 20% of dogs with lymphoma and 13% with NHN had a subnormal ACTH response. eACTH levels were below the reference range in 10% of dogs with lymphoma and 7% with NHN. Overall, 10 adrenal glands were enlarged in seven dogs, five with lymphoma and two with NHN. The clinical significance of these findings remains to be determined.     

Ultrasonographic examination of the adrenal gland and evaluation of the hypophyseal-adrenal axis in 20 cats

The adrenal glands of 20 healthy, non-sedated cats were examined ultrasonographically; visualisation and assessment was possible in all cases. In comparison with the surrounding tissue, the adrenal glands were hypoechoic and two distinct zones could be differentiated in six of the cats. The length and width of the adrenal glands varied from 0.45 to 1.37 cm and 0.29 to 0.53 cm, respectively, and both dimensions could be reliably reproduced. The adrenal glands did not differ between male and female cats, and, in comparison to dogs, those of cats are more easily visualised ultrasonographically. The basal cortisol value ranged from 2.0 to 79 micrograms/litre. Values 30 and 60 minutes after administration of ACTH (0.125 mg/cat intramuscularly) varied from 36 to 126 micrograms/litre. The basal value of aldosterone ranged from 4 to 618 pg/ml. Values 30 and 60 minutes after administration of ACTH varied from 100 to 832 pg/ml. In all cats, suppression of the cortisol value below the level of detection (< 2.0 micrograms/litre) occurred four and eight hours after the administration of dexamethasone (0.1 mg/kg intravenously).     

Changes in adrenal cortisol secretion as reflected in the urinary cortisol/creatinine ratio in dogs

In Experiment 1, voided urine samples were collected from 12 adult dogs at 0500, 1400, and 2200 hr for 4 days. Cortisol was measured in unextracted urine by radioimmunoassay, creatinine by spectrophotometry, and the cortisol/creatinine ratio (UCCR) was calculated for each sample. There was considerable variation both within and among dogs in UCCR but there was no consistent time of day fluctuation in UCCR. In Experiment 2, these dogs were randomly assigned to 1 of 4 groups. The groups received each of 4 treatments (saline, dexamethasone, ACTH gel, and aqueous ACTH) at 7 day intervals in a Latin square design. All urine was collected from 0 through 8 hr. Blood samples were collected at 20 minute intervals from 0 through 8 hr. Plasma cortisol exposure was determined by quantifying area under the curve (AUC). UCCR measurement was shown to differentiate basal from elevated, but not lowered, cortisol secretion. A positive linear relationship between UCCR and AUC was seen for all treatments except dexamethasone. These results indicate that changes in cortisol secretion are reflected in changes in UCCR, but measurement of UCCR may lack sensitivity to differentiate basal from reduced states of cortisol secretion. In Experiment 3, urine was collected daily before and during induction therapy with o,p′-DDD from dogs with pituitary-dependent hyperadrenocorticism. Successful suppression of the adrenal glands was accompanied by a progressive decrease in UCCR. There was considerable variation in the rate of adrenal suppression.     

Dexamethasone in cattle: pharmacokinetics and action on the adrenal gland

The pharmacokinetics of Dexamethasone (DXM) was studied in four cows all of which received DXM alcohol and DXM 21 isonicotinate (as a solution) by the intravenous and intramuscular routes. Concentrations of DXM and cortisol were determined using high performance liquid chromatography. An additional study was made in a second group of four cows which received intramuscular DXM 21 isonicotinate suspension for the assessment of DXM suppression of adrenal gland function. This was determined by measurements of base-line and ACTH-stimulated cortisol concentrations, before and following DXM administration. Following intravenous administration, the disposition kinetics of both formulations were described by a two-compartment open model. The half-times of elimination were similar; 335 and 291 min, respectively, for DXM alcohol and DXM 21 isonicotinate. All other pharmacokinetic parameters were not statistically different indicating that DXM was almost totally available (from DXM 21 isonicotinate). Following intramuscular administration, no significant difference in parameters was observed between the two formulations. Peak plasma concentrations were reached at 3 to 4 h post injection and bioavailability was approximately 70%. DXM was not detected in the plasma after the intramuscular administration of the suspension. The mean control plasma cortisol concentration was 8.8 ± 3.03 ng/ml. Following intravenous and intramuscular administrations of DXM alcohol and DXM 21 isonicotinate (solution), cortisol concentrations initially increased. However, at 120 min (intravenous) and 2–4 h (intramuscular), concentrations were negligible; 24–72 h and 48–96 h, respectively elapsed before concentrations returned control values. Following DXM 21 isonicotinate (suspension) there was no initial increase and concentrations had not returned to normal in all four cows until 52 days post administration. Similarly, ACTH-stimulated plasma cortisol concentrations decreased progressively and significantly post administration. At 52 days, response to ACTH was normal in all animals.     

Dynamic adrenal function testing in eight dogs with hyperadrenocorticism associated with adrenocortical neoplasia.

The results of adrenocorticotropin (ACTH) stimulation and low-dose dexamethasone suppression tests (LDDST) were evaluated retrospectively in eight dogs with clinical signs of hyperadrenocorticism arising from functional adrenocortical tumours, and compared with the results from 12 dogs with confirmed pituitary-dependent hyperadrenocorticism (PDH). The post-ACTH cortisol concentration in the dogs with adrenocortical tumours ranged from 61 to 345-6 nmol/litre (median 251.5 nmol/litre) and they were within the reference range (150 to 450 nmol/litre) in five and unexpectedly low (< 150 nmol/litre) in three dogs. Both the basal and post-ACTH cortisol concentrations were significantly lower in the dogs with adrenocortical neoplasia than in the dogs with PDH. Eight hours after the LDDST, only two of six dogs with adrenocortical tumours had a cortisol concentration above 30 nmol/litre, and the median resting, three, and eight-hour cortisol concentrations were 31.5, 23.0, and 22.7 nmol/litre respectively. There was no significant cortisol suppression during the LDDST, although interpretation was complicated by the low cortisol concentrations, but two dogs showed a pattern of apparent suppression. Two dogs with adrenal tumours showed a diagnostically significant increase in 17-OH-progesterone concentration in response to ACTH although their cortisol concentrations did not increase greatly. These results differ from previous reports of the response of functional adrenal tumours to dynamic endocrine tests.     

白血病抑制因子及其受体与子宫内膜的关系

白血病抑制因子(LIF)是一种多生物活性的细胞因子,研究表明,LIF在人及动物的子宫内膜的腺上皮细胞、妊娠期蜕膜及胎盘上均有表达;胚泡是动物生殖过程中的关键,一些细胞因子起重要作用,它们能够充当子宫内膜微环境的"局部调节者",LIF对哺乳动物胚胎发育到胚泡阶段具有一定的作用,LIF在子宫内膜中特异性表达,促进胚胎生长发育和启动胚泡植入;LIF在生殖周期中影响子宫的功能及调节子宫内膜生长,这可能与LIF作用于子宫使其能发生蜕膜反应有关;LIF通过与LIF受体及gp130蛋白作用而发挥重要的生物学功能。LIF在哺乳动物早期妊娠中的作用机制具有重要意义。文章对LIF及其受体与子宫内膜的关系做了综述。     

Comparative effects of proligestone and megestrol acetate on basal plasma glucose concentrations and cortisol responses to exogenous adrenocorticotrophic hormone in cats

Cats were given megestrol acetate (MA, 5 mg once daily for 14 days), subcutaneous proligestone (PRG, 100 mg on two occasions one week apart) or subcutaneous saline (1 ml as for PRG). In cats given saline (n = 6) basal cortical concentrations, cortisol concentrations after adrenocorticotrophic hormone (ACTH) administration and fasting blood glucose concentrations did not change significantly during the following seven weeks. Cats given MA (n = 7) developed suppression of basal and ACTH-stimulated cortisol concentrations and fasting hyperglycaemia during treatment. Effects on cortisol persisted for two weeks after MA dosage ceased. In cats given PRG (n = 7), basal cortisol concentrations were reduced overall, but only three cats had persistently suppressed post-ACTH cortisol concentrations. Adrenal suppression continued for 14 weeks in one of these and for at least 22 weeks in two cats. Fasting blood glucose concentrations were unchanged in PRG-treated cats.     

Comparison of the hypothalamic–pituitary–adrenal axis in MDR1-1Δ and MDR1 wildtype dogs

Objective: To evaluate the hypothalamic–pituitary–adrenal (HPA) axis in MDR1‐1Δ (dogs with the MDR1 mutation associated with ivermectin sensitivity) and MDR1 wildtype dogs. Design: Prospective study. Setting: Institutional vivarium. Animals: Seven healthy Collie dogs. Measurements: MDR1 genotyping was used for allocation of dogs to 1 of 2 groups: dogs homozygous for the wildtype MDR1 allele (MDR1 wildtype) and those homozygous for the MDR1‐1Δ mutation (MDR1 mutant). Blood samples were obtained for determination of cortisol and adrenocorticotropin hormone (ACTH) concentrations under basal conditions, before and after ACTH administration, and before and after dexamethasone administration. Main results: Significant differences were identified between the MDR1 mutant and MDR1 wildtype groups. Basal plasma cortisol concentrations and cortisol concentrations after ACTH administration were significantly lower in MDR1 mutant dogs as compared with MDR1 wildtype dogs. Plasma ACTH concentrations after dexamethasone administration were significantly lower in MDR1 mutant dogs as compared with MDR1 wildtype dogs. Conclusions: Results suggest that P‐glycoprotein (P‐gp) plays a role in regulation of the HPA axis. Furthermore, it appears that the HPA axis in MDR1 mutant dogs that lack P‐gp is suppressed compared with MDR1 wildtype dogs. This finding may explain some clinical observations in breeds known to harbor the MDR1 mutation including Collies, Shelties, Australian Shepherds, and others. There is a clinical impression that many of these dogs have worse outcomes in response to stress and, at times, respond poorly to appropriate therapy. HPA axis suppression, secondary to the MDR1 mutation, could result in a relative adrenal insufficiency (RAI) state during times of stress or illness. Further studies are required to determine the relationship between the MDR1 genotype and RAI.     

Adrenocortical responses to tumor necrosis factor-alpha and interferon-gamma in cattle

The responses of plasma cortisol and adrenocorticotropic hormone (ACTH) were examined to intravenous injection of recombinant bovine tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (INF-gamma) in Holstein cows. INF-gamma induced dose-dependent rises in the plasma levels of both cortisol and ACTH, while TNF-alpha induced comparable plasma cortisol responses with much smaller rises in plasma ACTH. The results suggest a direct stimulatory action of TNF-alpha on cortisol secretion from the adrenal gland in cattle.     

Studies on equine prematurity 2: Post natal adrenocortical activity in relation to plasma adrenocorticotrophic hormone and catecholamine levels in term and premature foals

Adrenocortical and medullary function was investigated during the immediate post natal period in premature and full term foals. High plasma cortisol concentrations were characteristic of the term foals in the first 2 h after birth and these were accompanied by significant arteriovenous differences in plasma cortisol across the umbilical circulation at birth, indicating enhanced adrenal activity before delivery. No such arteriovenous differences were detected in the premature group and post natal changes in plasma cortisol were minimal. The apparent inability of the premature foal adrenal to secrete cortisol was not due to the lack of endogenous adrenocorticotrophic hormone (ACTH) because high levels of this hormone were found immediately after birth in both groups of foals. Tests on the sensitivity of the foal adrenal to exogenous ACTH1-24 (0.125 mg intramuscularly [im]) showed that a maximum response to this hormone could be elicited in term foals on the day of birth. Subsequently basal cortisol levels and the response of the adrenal to ACTH1-24 declined. By contrast, only a slight response was observed following the same dose of ACTH1-24 in the premature group. Exposure to Depot ACTH1-24 over 24 h enhanced the basal secretion of cortisol in both premature and term foals but no consistent response to the same ACTH test dose could be elicited in the former. A wide range of total plasma catecholamine concentrations was observed in both groups of newborn foals. The highest values were seen in acidotic animals and there was a significant inverse relationship between blood pH and total plasma catecholamine level at delivery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Adrenocorticotropin-containing neoplastic cells in a pars intermedia adenoma in a horse

Pituitary-dependent hyperadrenocorticism was diagnosed in a 14-year-old Arabian mare with chronic weight loss, hirsutism, polyuria, and polydipsia. The mare had a stress leukogram, glucosuria, and consistent hyperglycemia. Plasma glucose concentrations were resistant to suppression by insulin. Plasma cortisol concentrations were within normal limits, but did not respond to dexamethasone suppression and had an exaggerated response to ACTH stimulation. At necropsy, a chromophobe adenoma of the pars intermedia of the pituitary gland was found. The zona fasciculata of the adrenal cortex and the pancreatic islets of Langerhans were hypertrophied. An immunohistologic staining technique was used to demonstrate ACTH-containing neoplastic cells in the pituitary mass. These cells released ACTH and other peptides that initiated the chain of endocrinologic events leading to clinical disease.