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Adrenocorticotropin Hyperresponsiveness in Myotonic Dystrophy Following Oral Fenfluramine Administration
Author(s) -
Grice Jeffrey E.,
Jackson Jane,
Penfold Paula J.,
Jackson Richard V.
Publication year - 1991
Publication title -
journal of neuroendocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.062
H-Index - 116
eISSN - 1365-2826
pISSN - 0953-8194
DOI - 10.1111/j.1365-2826.1991.tb00241.x
Subject(s) - medicine , endocrinology , myotonic dystrophy , fenfluramine , serotonergic , vasopressin , placebo , muscular dystrophy , dystrophy , serotonin , alternative medicine , receptor , pathology
The plasma immunoreactive adrenocorticotropin and cortisol responses to oral fenfluramine hydrochloride (1.5mg/kg body wt) or placebo were examined in 11 patients with myotonic dystrophy, 4 controls with facioscapulohumeral dystrophy, a similarly debilitating muscle wasting disease, and 14 normal controls in single‐blind studies performed in mid‐afternoon. Mean areas under the adrenocorticotropin response versus time curve were significantly greater in myotonics (2573 + 429 pmol.min/L) than in facioscapulohumeral dystrophy controls (696 + 279 pmol.min/L, P<0.02) and normals (560±61 pmol.min/L, P<0.0001). Corresponding cortisol responses were significantly greater in myotonics (35757 + 3949 nmol.min/L) than in normals (21828±1669 nmol.min/L, P < 0.001), but not significantly greater than those in facioscapulohumeral dystrophy controls (22830 + 6140 nmol.min/L, P = 0.055). No stressful side‐effects which could affect hormone responses, and no significant changes in blood pressure or heart rate were noted. Fenfluramine activates central serotonergic and/or noradrenergic pathways initiating secretion of corticotropin‐releasing hormone and possibly arginine vasopressin. We postulate that these fenfluramine‐activated pathways are hyperstimulated in myotonics, leading to adrenocorticotropin and cortisol hypersecretion. This may be a manifestation of a general cell membrane defect in myotonic dystrophy. We found a lack of correlation of age (and severity of disease) with adrenocorticotropin response in myotonics, and therefore, the hyperresponse may serve as a useful marker for the disease before development of other overt signs.