Evidence of 11 beta-hydroxylase deficiency in a patient with cortical adrenal adenoma

We explored a 61 year old woman with mild hirsutism. An adrenal tumor was found in the left adrenal, which was held responsible for the androgen secretion. The in vitro incubation of the tumor tissue showed an impaired 11 beta-hydroxylation of 11-deoxycortisol. This is a rare and unusual case of adrenal pathology showing that a deficiency in 11 beta-hydroxylase activity does not rule out the presence of an adrenocortical adenoma.     

Coexistence of 21-hydroxylase and 11 beta-hydroxylase deficiency in adrenal incidentalomas and in subclinical Cushing's syndrome

OBJECTIVE: The prevalence of steroid secretion abnormalities was studied by evaluating the 17-hydroxyprogesterone (17-OHP) and 11-deoxycortisol (S) responses to adrenocorticotropic hormone (ACTH) stimulation in 48 patients with 'nonfunctioning' incidentalomas and in 10 patients with 'subclinical' Cushing's syndrome. METHODS: In all patients the cortisol, 17-OHP, and S levels were measured after ACTH test. Eight patients were reinvestigated after surgery. RESULTS: In patients with nonfunctioning lesions, the ACTH test induced 17-OHP and S peaks higher than in normals (p < 0.005). In 10 cases an augmented rise of 17-OHP and S was observed. In patients with subclinical Cushing's syndrome, the 17-OHP peak after ACTH was greater than in patients with nonfunctioning lesions and in normals (p < 0.005); the S peak was also higher than in controls (p < 0.005). In 7 of 8 operated patients, the exaggerated 17-OHP peak was normalized. CONCLUSIONS: A combined impairment of different enzyme activities is frequently present in adrenal incidentalomas; the alteration of enzymatic pathways can also coexist with the presence of partial cortisol autonomy.     

Increased adrenal androgen secretion with inhibition of 11beta-hydroxylase in HIV-infected women

Adrenal androgen production is reduced in association with disease severity in HIV-infected women. This response may be maladaptive in terms of maintenance of lean body mass, functional status, and immune function. The aim of this study was to assess whether the use of an adrenal enzyme inhibitor of 11beta-hydroxylase might increase androgen production in this population. We conducted a randomized, double-blind, placebo-controlled study of metyrapone (500 mg p.o. qid) or placebo for 2 wk in 10 HIV-infected women with AIDS wasting [weight <90% ideal body weight (IBW) or weight loss >10%] and reduced androgen levels. Basal and ACTH-stimulated androgen, mineralocorticoid, and glucocorticoid levels were measured at baseline and after 14 days of treatment. Subjects were similar in age (40.9 +/- 0.9 yr), weight (91.7 +/- 3.5% IBW) and hormone concentrations at study entry. Total testosterone (84 +/- 54 vs. -0.4 +/- 2 ng/dl, P = 0.024), free testosterone (6.5 +/- 2.8 vs. 0.1 +/- 0.1 pg/ml, P = 0.024), DHEA (5.0 +/- 3.2 vs. -0.6 +/- 0.5 microg/l, P = 0.024), and 11-deoxycortisol (2,145 +/- 820 vs. -14 +/- 22 ng/dl, P = 0.024) levels increased in response to metyrapone compared with placebo treatment. In response to ACTH, significant increases in the DHEA/cortisol ratio (174 +/- 48 vs. 3 +/- 3, P = 0.008) were seen in the metyrapone group compared with placebo. Blood pressure and electrolytes did not change, and signs of adrenal insufficiency were not apparent. These data demonstrate that inhibition of 11beta-hydroxylase with metyrapone increases adrenal androgen secretion in HIV-infected women. Further studies are needed to assess the physiological effects of this strategy to increase anabolic hormone levels in severe stress, including detailed testing to rule out the potential risk of concomitant adrenal insufficiency.     

Adriamycin as an inhibitor of 11 beta-hydroxylase activity in adrenal cortex mitochondria

Inhibition of 11 beta-hydroxylase activity was observed to be due to the interaction of adriamycin with adrenal cortex mitochondria. The inhibition of the enzyme was uncompetitive, with an apparent Ki of 100 microM, and was dependent upon the concentration of the drug and the time of incubation. Adriamycin increased the oxygen consumption of these mitochondria. EPR studies showed that adriamycin was reduced to a free radical semiquinone which served to shuttle electrons to oxygen, leading to an impairment in the reduction of cytochrome P450. It is suggested this may be the mechanism for the inhibitory effect of the drug on 11 beta-hydroxylase activity.     

Facilitation of sexual receptivity in female mice through blockade of adrenal 11 beta-hydroxylase

Ovariectomized mice were given replacement estrogen and progesterone, and tested for sexual receptivity in the presence of mounting males after various pharmacological manipulations of adrenocortical hormone activity. In Experiment I, females received a chronic regimen of varied dosages of metyrapone, which blocks adrenal conversion of desoxycorticosterone to corticosterone. In each of three repeated measures, females given an intermediate dosage (800 micrograms/animal/injection) showed substantially higher levels of receptivity than those given vehicle injections or other dosages. In Experiment 2, corticosterone administration reversed the facilitatory action of metyrapone on receptivity. In Experiment 3, chronic administration of either desoxycorticosterone or progesterone failed to elevate receptivity. These findings suggest that corticosterone titer may play a role in modulating female receptivity in sexually inexperienced mice.     

Regulation of dopamine beta-hydroxylase in rat adrenal glands.

Rat adrenal gland levels of dopamine beta-hydroxylase are subject to dual control. Activation of the splanchnic nerves to the adrenal medulla by reserpine induces the synthesis of dopamine beta-hydroxylase without altering the rate of enzyme degradation. In contrast, hypophysectomy causes a decline in steady state dopamine beta-hydroxylase levels by first accelerating the rate of degradation, then by slowing the rate of enzyme synthesis as well. Adrenocorticotropic hormone administration partially reversed the effect of hypophysectomy on dopamin beta-hydroxylase degradation. These findings suggest that the trans-synaptic factors controlling dopamine beta-hydroxylase induction act by a different mechanism (enzyme synthesis) than the hormonal controls regulating steady state levels (enzyme degradation). Thus, active inhibition of enzyme degradation may be an important control in maintenance of steady state enzyme levels.     

The use of high-pressure liquid chromatography in the simultaneous assay of 11beta-hydroxylase and 18-hydroxylase in zona fasciculata-reticularis tissue of the rat adrenal cortex.

Certain reagents utilized in the formation of polyacrylamide gels are shown to interfere in the Lowry assay for protein. Acrylamide (3–30%) and potassium ferrocyanide (0.0015–0.0105%) produced a linear response in color formation. Both compounds are capable of reducing the phenol reagent in the absence of copper and the interference can be compensated for by employing the appropriate blank. An extract of polymerized and electrophoresed gels also interferes in the Lowry assay, however, this increased color formation cannot be corrected by using a gel extract blank. Under the conditions studied, filtration, centrifugation, and dialysis did not sufficiently remove the acrylamide fines responsible for the interference.     

The effects of nicotine, cotinine and anabasine on rat adrenal 11 beta-hydroxylase and 21-hydroxylase

The effects of nicotine, cotinine and anabasine on rat adrenal steroidogenesis were examined by spectral and enzymatic techniques. The addition of nicotine, cotinine or anabasine to preparations of rat adrenal mitochondria produced type II cytochrome P-450 difference spectra. The addition of nicotine or anabasine, but not cotinine, to rat adrenal microsomes yielded type II cytochrome P-450 difference spectra. Nicotine and anabasine competitively inhibited rat adrenal mitochondrial 11 beta-hydroxylase and microsomal 21-hydroxylase. Cotinine competitively inhibited mitochondrial 11 beta-hydroxylase, but did not inhibit microsomal 21-hydroxylase. The apparent enzymatic inhibition constants for cotinine, nicotine, anabasine and metyrapone inhibition of the mitochondrial 11 beta-hydroxylase were 32, 96, 120 and 74 microM respectively. These studies suggest that components of cigarette smoke may alter patterns of adrenal steroidogenesis.     

Primary retroperitoneal carcinosarcoma in a child: a case report

Background

Lymphadenectomy is an integral part of the staging system of epithelial ovarian cancer. However, the extent of lymphadenectomy in the early stages of ovarian cancer is controversial. The objective of this study was to identify the lymph node involvement in unilateral epithelial ovarian cancer apparently confined to the one ovary (clinical stage Ia).

Methods

A prospective study of clinical stage I ovarian cancer patients is presented. Patient's characteristics and tumor histopathology were the variables evaluated.

Results

Thirty three ovarian cancer patients with intact ovarian capsule were evaluated. Intraoperatively, neither of the patients had surface involvement, adhesions, ascites or palpable lymph nodes (supposed to be clinical stage Ia). The mean age of the study group was 55.3 ± 11.8. All patients were surgically staged and have undergone a systematic pelvic and paraaortic lymphadenectomy. Final surgicopathologic reports revealed capsular involvement in seven patients (21.2%), contralateral ovarian involvement in two (6%) and omental metastasis in one (3%) patient. There were two patients (6%) with lymph node involvement. One of the two lymph node metastasis was solely in paraaortic node and the other metastasis was in ipsilateral pelvic lymph node. Ovarian capsule was intact in all of the patients with lymph node involvement and the tumor was grade 3.

Conclusion

In clinical stage Ia ovarian cancer patients, there may be a risk of paraaortic and pelvic lymph node metastasis. Further studies with larger sample size are needed for an exact conclusion.     

Reconstruction and study of a multi-enzyme system by 11 beta-hydroxylase steroids

The reconstitution of the steroid 11 beta-hydroxylase system based on the homogeneous proteins isolated from bovine adrenocortical mitochondria, cytochrome P-450 (P-450 (11 beta), 19-20.5 nmol of heme P-450 per 1 mg of protein), adrenodoxin (Adx) and adrenodoxin reductase (AR) was carried out. The reconstitution of the multienzyme system requires the presence of a non-ionic detergent due to the high hydrophobicity of P-450 (11 beta). Low concentrations of Tween 20 (below 0.015% or 115 microM) stimulate the reaction of steroid 11 beta-hydroxylation by improving the hemoprotein solubility. With a further increase in the detergent concentration, the reaction is inhibited due to the inactivation of the cytochrome and its impaired interaction with Adx. The electron transfer activity of adrenodoxin reductase and the dienzyme AR-Adx complex does not change within the Tween 20 concentration range of 0-0.4%. In solutions with the optimal concentration of Tween 20 (0.010-0.015%), the concentrations of AR and Adx providing for the half-maximum hydroxylation activity are 9 nM for AR and 280 nM for Adx. It was shown that in a reconstituted 11 beta-hydroxylase system, 75% of the reducing equivalents are involved in the formation of oxygen radicals, whereas 25%--in hydroxylation. 74% of the radical species are, in their turn, formed in the active site of the hemoprotein, while 26%--in the Fe2S2 center of adrenodoxin. The radical formation process predominates over the 11 beta-hydroxylation within a wide range of Adx/cytochrome ratios, i.e., 1.0-100. The hydroxylation substrate induces a 4-fold increase in the electron transfer rate by stimulating the enzymatic reduction of P-450 (11 beta), but only 35% of the additional reduced equivalents are consumed by the 11 beta-hydroxylation and 65%--by the oxygen radical formation.     

The effects of enzyme concentration on the kinetic behavior of adrenal 21-hydroxylase and 11beta-hydroxylase in the pregnant rat.

Experiments were designed to study the kinetic behavior of 21-hydroxylase and 11beta-hydroxylase as a function of enzyme concentration (Et) during proestrus, dasy 5 (D5), 12 (D12), and 22 (D22) of pregnancy, and within 24 h post-partum. The enzymes were prepared from rat adrenal microsomes and mitochondria, respectively. The experiments consisted of measuring the initial velocity of each reaction for a series of substrate concentrations at three fixed Et. Double reciprocal plots were constructed and the slope (Km/Vmax) of each line estimated. Variation in the value of the slope as a function of enzyme dilution would predict the presence of an endogenous effector. The kinetic behavior of 21-hydroxylase was not altered throughout the range of Et (10-100 microgram protein) at any of the reproductive stages. In contrast, kinetic behavior of 11beta-hydroxylase was clearly dependent upon Et. Dilution of the enzyme preparation (25-200 microgram of protein) increased the slope of the double reciprocal plot at all reproductive stages, thus suggesting that an activator substance may be present within the mitochondrial preparation. A secondary plot of the slope (Km/Vmax) versus Et described a power function (Km/Vmax = a [Et]b) with the greatest rate of change in Km/Vmax occurring at low values of Et. The rate of change in Km/Vmax per mg rise in mitochondrial protein at all dilutions of enzyme was greatest for proestrus and post-partum, followed by D22 greater than D12 greater than D5. In addition, repeated washing of the enzyme preparation at 4 degrees C increased Km/Vmax to a greater extent at all Et than did the control preparation. These findings suggest the presence of a diffusible endogenous activator of 11beta-hydroxylase whose influence decreases markedly at D5 and D12. On the other hand, there is no evidence to suggest the presence of a diffusible endogenous effector for 21-hydroxylase.