CORRELATION BETWEEN IMPAIRMENT OF GLUCOCORTICOID FEEDBACK AND THE SIZE OF THE PITUITARY-GLAND IN DOGS WITH PITUITARY-DEPENDENT HYPERADRENOCORTICISM

Under the assumption that the impaired inhibitory effect of glucocorti coids on cell division is an important determinant in the progression of corticotrophic adenomas, it is postulated that the magnitude of pro liferation and the resistance to glucocorticoids are correlated. To te st this hypothesis, 67 dogs with pituitary-dependent hyperadrenocortic ism were studied to determine whether a correlation could be demonstra ted between the effect of dexamethasone administration on the activity of the pituitary-adrenocortical axis and the size of the pituitary gl and as estimated by computed tomography. The volumes of the pituitary glands as calculated from summations of subsequent images of pituitary areas, ranged from 11.8 to 3238.6 mm(3). Among the three dimensions, the height of the pituitary was the most sensitive indicator of enlarg ement. Calculation of the pituitary height/brain area ratio (P/B ratio ) allowed correction for the size of the dog. The P/B ratio had the hi ghest discriminatory power in distinguishing enlarged (n=41) from non- enlarged (n=26) pituitaries. The effects of dexamethasone (0.1 mg/kg) on the plasma concentrations of cortisol and ACTH and on the urinary c orticoid/creatinine (C/C) ratios were expressed as percentage changes from the initial values. For ACTH, cortisol and C/C ratios these figur es for resistance to dexamethasone were significantly correlated with the dimensions of the pituitary, particularly the height, volume and P /B ratio. It is concluded that the magnitude of the expansion of pitui tary corticotrophic adenomas is dependent upon the loss of restraint b y glucocorticoids, i.e. the degree of insensitivity to glucocorticoid feedback.