thyrotropin-releasing hormone stimulation test

Thyrotropin-releasing hormone

[thahy-ruh-troh-pin ri-lee-sing, thahy-ro-truh-]

Thyrotropin-releasing hormone (TRH), also called thyrotropin-releasing factor (TRF), thyroliberin or protirelin, is a tropic tripeptide hormone that stimulates the release of thyroid-stimulating hormone and prolactin by the anterior pituitary.

Production

TRH is produced by the hypothalamus in medial neurons of the paraventricular nucleus. Initially, it is synthesized as a 242 amino acid precursor polypeptide that contains 6 copies of the sequence -Glu-His-Pro-Gly-, flanked by di-basic peptides that are later processed through proteolysis to give the mature TRH molecule.

It travels across the median eminence to the anterior pituitary gland via the hypophyseal portal system where it stimulates the release of thyroid stimulating hormone from cells called thyrotropes.

In addition to the brain, TRH can also be detected in other areas of the body including the gastrointestinal system and pancreatic islets.

History

The sequence of TRH was first determined and the hormone synthesized by Roger Guillemin and Andrew V. Schally in 1969.

Chemical properties

Its molecular weight is 359.5 Da.

Its structure is: (pyro)Glu-His-Pro-NH2

Clinical significance

It is used in pharmacology (brand name Relefact TRH) to test the response of the anterior pituitary gland.

Medical preparations of TRH are used in diagnostic tests of thyroid disorders and in acromegaly.

A TRH test may be indicated if secondary hypothyroidism is suspected. Some patients may have low levels of circulating thyroid hormones and secondary hypothyroidism as a result of damage to the hypothalamic or pituitary control mechanisms that regulate thyroid function. The hypothalamus makes a small hormone called TRH that directs the synthesis and secretion of TSH from the pituitary gland. If these normal regulatory mechanisms are interrupted, the pituitary may not be able to produce appropriate levels of TSH and levels of thyroid hormones may decline, although the TSH remains appropriately normal. The TRH test involves administration of a small amount of TRH intravenously, following which levels of TSH will be measured at several subsequent time points using samples of blood taken from a peripheral vein. Patients with normal function of the hypothalamic-pituitary axis (HPA) respond by increasing the levels of TSH following TRH injection. Patients with compromised HPA function may exhibit a delayed, blunted, or absent response to TRH administration. TRH may cause nausea, vomiting and some patients experience an urge to urinate. Rarely, TRH may cause blood vessel constriction leading to hemorrhage in patients with pre-existing pituitary tumors. Accordingly, patients should be advised about the risks, albeit rare, of TRH testing.

See also

References

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