PreproTRH(158-183) fails to affect pituitary-adrenal response to CRH/vasopressin in man: a pilot study.

Non-glucocorticoid inhibitors of the HPA-system are of utmost interest in the treatment of diseases with impaired regulation of this system, like the metabolic syndrome and depression. In rats, a fragment of the thyreotropin-releasing hormone (TRH) preprohormone, preproTRH((178-199)), has been demonstrated to inhibit basal and stimulated secretion of cortisol. Our pilot study aimed to explore the first time similar effects of the homologue peptide preproTRH((158-183)) in healthy humans. In a double-blind within-subject comparison, eight healthy young men were infused intravenously with placebo and preproTRH((158-183)) at varying doses of 5, 10, 25 and 50 mg/kg of body weight. After 15 min of infusion a corticotropin-releasing hormone (CRH)/vasopressin-test was performed. Plasma concentrations of pituitary hormones and free thyroxine, blood pressure, heart rate and feelings of activation and mood were assessed repeatedly at close intervals. Individual hormone profiles and collapsed data across all doses did not reveal any effects of preproTRH((158-183)) on HPA-activity, although it increased TSH and fT4, stimulated the release of GH and increased systolic blood pressure in the course of the experiment (p<0.05, for all effects). Self-reports indicated enhanced feelings of activation and general well-being following preproTRH (p<0.05). Our data exclude a substantial inhibitory effect of preproTRH((158-183)) on HPA secretory activity and, thus, contrast with findings in rats. In humans, the peptide appears to even exert an albeit weak stimulatory effect on autonomic stress systems as indicated by increased cardiovascular activity in combination with enhanced subjective arousal.

[Coxitis fugax--the beginning of Perthes' disease?]. / Die Coxitis fugax -- Vorstufe des Morbus Perthes?

We present the clinical case of a decennial boy with acute leftsided hip pain without appropriate trauma. The initial diagnosis of coxitis fugax was verified in this case with inconspicuous blood parameters and X-ray by a sonographically proven intraarticular effusion. An immediate magnet resonance imaging (MRI) study of the affected hip joint was done. Here, a complete "necrosis" of the proximal femur epiphysis was verified. With knowledge of these results, an immediate operation of the hip joint with a ventral capsule incision and consecutive intraarticular decompression was performed. A complete reperfusion of the femur head was evident in the MRI scan seven days postoperatively. In accordance with this clinical case report, we would like to point out the necessity for the immediate diagnosis of indifferent hip pain by means of MRI, especially for patients in the atypical "critical age" (> or = 8 years) for coxitis fugax. This is discussed under consideration of the possible aetiopathogenesis and the current literature.