Efeito da corticotropina sobre a absorção de vitamina B12 na mielose funicular

Canelas, Horacio M.; Carvalho, Nelson de; Rocha, Arnaldo Gama da

doi:10.1590/S0004-282X1965000200002

Resumos

Foi estudada a absorção de vitamina B12 em 9 casos de mielose funicular antes e após a administração de ACTH por via intravenosa em um esquema terapêutico com duração variável entre 19 e 43 dias. Em 7 casos foi verificado aumento da absorção. A diferença média de modificação no teste de excreção urinaria de vitamina B12 radioativa situou-se próximo do nível de significancia estatística. Este resultado reforça a indicação do emprego de corticotropina na mielose funicular, pois o hormônio irá atuar tanto sobre o componente alérgico do prccesso desmielinizante, quanto sobre a carência de vitamina B12 resultante do déficit de absorção. Embora o material aqui analisado seja muito pequeno para garantir uma conclusão definitiva, nossos resultados demonstram que, provavelmente, o ACTH age sobre a absorção da vitamina B12 através da mucosa intestinal, e não mediante o aumento de secreção do fator intrínseco ou a mobilização dos depósitos dessa vitamina. In order to study a possible mobilizing effect of ACTH on the radioactive vitamin B12 stores, the intervals between the last urinary excretion test and the test after completion of treatment were analyzed (Table 1). It is easily noticed that in the 7 cases with increase of vitamin B12 absorption these periods were the most varied, lasting from 9 to 62 days. And also in the 2 cases with decrease of absorption the intervals were very dissimilar, namely 15 and 56 days. So, it seems that this effect of ACTH did not play a significant role in the results. Likewise, the time elapsed between the completion of treatment and the repetition of the Schilling's test had no apparent relationship with the results.

The absortion of vitamin B12 was studied in 9 cases of subacute combined degeneration of the spinal cord before and after the administration of intravenous ACTH in a therapeutic scheme lasting from 19 to 43 days. In 7 cases an increase of absorption was evidenced. The mean difference of change in the urinary excretion test of radioactive vitamin B12 was near the limit of significance. This finding reinforces the indication of the use of corticotropin in subacute combined degeneration of the spinal cord, since the hormone will act both on the allergic component of the demyelinating process and on the deficiency of vitamin B12 absorption. Though the material here analyzed is too small to.warrant a definite conclusion, our results suggest that ACTH influences the vitamin B12 absorption through the intestinal wall, and not by means of an increase of intrinsic factor secretion or a mobilization of vitamin B12 stores.

Effect of corticotropin on the absorption of vitamin B₁₂ in the subacute combined degeneration of the spinal cord

Efeito da corticotropina sobre a absorção de vitamina B₁₂ na mielose funicular

Horacio M. Canelas^I; Nelson de Carvalho^II; Arnaldo Gama da Rocha^I

^I(Chairman: Prof. Adherbal Tolosa) and the Center of Nuclear Medicine; From the Department of Neurology of the Medical School

^II(Head: Dr. Tede Eston de Eston) of the University of São Paulo; From the Department of Neurology of the Medical School

ABSTRACT

The absortion of vitamin B₁₂ was studied in 9 cases of subacute combined degeneration of the spinal cord before and after the administration of intravenous ACTH in a therapeutic scheme lasting from 19 to 43 days. In 7 cases an increase of absorption was evidenced. The mean difference of change in the urinary excretion test of radioactive vitamin B₁₂ was near the limit of significance.

This finding reinforces the indication of the use of corticotropin in subacute combined degeneration of the spinal cord, since the hormone will act both on the allergic component of the demyelinating process and on the deficiency of vitamin B₁₂ absorption. Though the material here analyzed is too small to.warrant a definite conclusion, our results suggest that ACTH influences the vitamin B₁₂ absorption through the intestinal wall, and not by means of an increase of intrinsic factor secretion or a mobilization of vitamin B₁₂ stores.

RESUMO

Foi estudada a absorção de vitamina B₁₂ em 9 casos de mielose funicular antes e após a administração de ACTH por via intravenosa em um esquema terapêutico com duração variável entre 19 e 43 dias. Em 7 casos foi verificado aumento da absorção. A diferença média de modificação no teste de excreção urinaria de vitamina B₁₂ radioativa situou-se próximo do nível de significancia estatística.

Este resultado reforça a indicação do emprego de corticotropina na mielose funicular, pois o hormônio irá atuar tanto sobre o componente alérgico do prccesso desmielinizante, quanto sobre a carência de vitamina B₁₂ resultante do déficit de absorção. Embora o material aqui analisado seja muito pequeno para garantir uma conclusão definitiva, nossos resultados demonstram que, provavelmente, o ACTH age sobre a absorção da vitamina B₁₂ através da mucosa intestinal, e não mediante o aumento de secreção do fator intrínseco ou a mobilização dos depósitos dessa vitamina.

In order to study a possible mobilizing effect of ACTH on the radioactive vitamin B₁₂ stores, the intervals between the last urinary excretion test and the test after completion of treatment were analyzed (Table 1). It is easily noticed that in the 7 cases with increase of vitamin B₁₂ absorption these periods were the most varied, lasting from 9 to 62 days. And also in the 2 cases with decrease of absorption the intervals were very dissimilar, namely 15 and 56 days. So, it seems that this effect of ACTH did not play a significant role in the results.

Likewise, the time elapsed between the completion of treatment and the repetition of the Schilling's test had no apparent relationship with the results.

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Clínica Neurológica - Faculdade de Medicina da Universidade de São Paulo - Caixa Postal 3461 - São Paulo, Brasil

1. ADAMS, J. F., and TIMBURY, G. C. - Subacute combined degeneration developing during liver therapy. Brit. med. J. i: 833-834, 1959.
2. BJÖRKENHEIM, G. - Neurological changes in pernicious tapeworm anaemia. Acta med. scand., suppl. 260, 1951.
3. BOUDIN, G.; BARBIZET, J., and LABET, R. - Les neuropathies achyllques. Rev. neurol. 91:361-366, 1954.
4. CANELAS, H. M. - Mieloses funiculares: considerações a propósito de 110 casos. Arq. Neuro-psiquiat. (S. Paulo) 18:105-132, 1960.
5. CANELAS, H. M., and LEVY, J. A. - Resultados preliminares do emprêgo do ACTH nas degenerações combinadas da medula. Arq. Neuro-psiquiat. (S. Paulo) 11:253-258, 1953,
6. CANELAS, H. M.; TEIXEIRA-PINTO, J., and SHNAIDER, J. - Absorção da vitamina B₁₂ nas mieloses funiculares: estudo da absorção da radio-cianocobalamina em 16 casos. Arq. Neuro-psiquiat. (S. Paulo) 19:1-10, 1961.
7. DOIG, R. K. - Gastric biopsy and the investigation of the megaloblastic anaemias. Proc. roy. Soc. Med. 47:425-431, 1954.
8. DOIG, A., GIRDWOOD, R. H., DUTHIE, J. J. R., and KNOW, J. D. E. - Response of megaloblastic anaemia to prednisolone. Lancet, ii: 966-972, 1957.
9. FROST, J. W., and GOLDWEIN, M. I. - Observation on vitamin B₁₂ absorption in primary pernicious anemia during administration of adrenocortical steroids. New Engl. J. Med. 258:1096-1098, 1958.
10. FROST, J. W., GOLDWEIN, M. I., and KAUGMAN, B. D. - Studies of B₁₂ Co⁶⁰ absorption in malabsorption syndrome: results before and during specific therapy. Ann. intern. Med. 47:293-299, 1957.
11. GEIGER, W., and Fuhrmann, W. - Zur Differentialdiagnose der funikulären Spinalerkrankung. Nervenarzt, 24:290-298, 1953.
12. GÉLIN, G.; COI-RAULT, R., and HAMED, E. B. - Vitamine B₁₂ et syndromes neuro-anémiques. Ann. Méd. 53:172-216, 1952.
13. GLASS, G. B. J. - Biochemistry and physiology of Castle's intrinsic factor and its relationship to the metabolism of vitamin B₁₂ Rev. Hémat. 10:137-179, 1955.
14. GLASS, G. B. J. - Intestinal absorption and hepatic uptake of vitamin B₁₂ in diseases of the gastrointestinal tract. Gastroenterology, 30:37-52, 1956.
15. GLASS, G. B. J. - Gastric intrinsic factor and its function in the metabolism of vitamin B₁₂ Physiol. Rev. 43:529-849, 1963.
16. GORDIN, R. - Vitamin B₁₂ absortion in corticosteroid-treated pernicious anaemia. Acta. med. scand. 164:159-165, 1959.
17. HALVORSEN, S. - Effects of ACTH on erythropoiesis in rabbit. Acta physiol. scand. 58:30-39, 1963.
18. HSU, J. M., and CHOW, B. F. - Effect of pyridoxine deficiency on the absorption of vitamin B₁₂ Arch. Biochem. Biophys. 72:322-330, 1957.
19. JEWESBURY, E. C. - Subacute combined degeneration of the cord and achlorhydric peripheral neuropathies without anaemia. Lancet, ii: 307-312, 1954.
20. KOLB, L. C. - The relationship of the demyelinating diseases to allergic encephalomyelitis. Medicine, 29:99-121, 1950.
21. KRISTENSEN, H. P. O., and FRIIS, R. - Effect of prednisone on B₁₂ absorption in pernicious anemia. Acta med. scand. 166:249-254, 1960.
22. LAFON, R., PAGES, P., LABAUGE, R., and TEMPLE, J. P. - Le syndrome neuroanachlorhydrique: à propos de 31 observations. Rev. neurol. 91:321-329, 1954.
23. MINOT, G. R., and MURPHY, W. P. - Treatment of pernicious anemia by a special diet. J. Amer. med. Ass. 87:470-476, 1926.
24. MOLLIN, D. L., and ROSS, G. I. M. - Vitamin B₁₂, deficiency in the megaloblastic anemia. Proc. roy. Soc. Med. 47:428-431, 1954.
25. MURPHY, W. P., and HOWARD, I. - A comparison of the effect of vitamin B₁₂ with that of liver extract in the treatment of pernicious anemia during relapse and for maintenance. New Engl. J. Med. 247:838-840, 1952.
26. NAKAHARA, I., and SAKAMOTO, Y. - Studies on pyridoxine metabolism. VIII: The effect of adrenal and hypophyseal hormones on pyridoxine metabolism. J. Biochem. 52:358-362, 1962.
27. RICHMOND, J., and DAVIDSON, S. - Subacute combined degeneration of the spinal cord in non-addiso-nian megaloblastic anaemia. Quart. J. Med. 27:517-531, 1958.
28. ROGER, H. - Les syndromes neuro-anémiques. Marseille méd., 91:473-490, 1954.
29. SCHILLING, R. G. - Intrinsic factor studies. II: The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B₁₂ J. Lab. clin. Med. 42:860-866, 1953.
30. SIURALA, M., and TA WAST, M. - Neurological changes in idiopathic atrophic gastritis. Ann. Med. intern. Fenn. 44:13-24, 1955.
31. SPIES, T. D., LOPEZ, G. G., MILANÊS, F., ARAMBURU, T., and TOCA, R. L. - Association between gastric achlorhydria and subacute combined degene- ration of the spinal cord. Postgrad. Med. 4:89-95, 1948.
32. SPILLANE, J. D., and WELLS, C. E. C. - Nutritional disorders of the nervous system. In Elliott, K. A. C, Page, I. H. & Quastel, J. H.: Neurochemistry, 2nd ed. Charles C. Thomas, Springfield, 1962, pp. 930-953.
33. STEVENSON, T. D. - Response of megaloblastic anaemia to prednisolone. Lancet, i :48, 1958.
34. VICTOR, M., and LEAR, A. A. - Subacute combined degeneration of the spinal cord: current concepts of the disease process. Amer. J. Med. 20:896-911, 1956.
35. WINTROBE, M. M. - The search for an experimental counterpart of pernicious anemia. Arch, intern. Med. 100:862-869, 1957.
36. YEH, S. D., and CHOW, B. F. - Vitamin B₁₂ absorption in pyridoxine-deficient rats. Amer. J. clin. Nutr. 7:426-432, 1959.
37. ZEMAN, W., and DeLAND, F. H. - Contribution to the pathogenesis of subacute combined degeneration of the spinal cord: report of two cases. Amer. J. clin. Path. 28:515-523, 1957.

Datas de Publicação

Publicação nesta coleção
15 Ago 2013
Data do Fascículo
Jun 1965

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADAMS, J. F., and TIMBURY, G. C. - Subacute combined degeneration developing during liver therapy. Brit. med. J. i: 833-834, 1959.

[2] 2. BJÖRKENHEIM, G. - Neurological changes in pernicious tapeworm anaemia. Acta med. scand., suppl. 260, 1951.

[3] 3. BOUDIN, G.; BARBIZET, J., and LABET, R. - Les neuropathies achyllques. Rev. neurol. 91:361-366, 1954.

[4] 4. CANELAS, H. M. - Mieloses funiculares: considerações a propósito de 110 casos. Arq. Neuro-psiquiat. (S. Paulo) 18:105-132, 1960.

[5] 5. CANELAS, H. M., and LEVY, J. A. - Resultados preliminares do emprêgo do ACTH nas degenerações combinadas da medula. Arq. Neuro-psiquiat. (S. Paulo) 11:253-258, 1953,

[6] 6. CANELAS, H. M.; TEIXEIRA-PINTO, J., and SHNAIDER, J. - Absorção da vitamina B₁₂ nas mieloses funiculares: estudo da absorção da radio-cianocobalamina em 16 casos. Arq. Neuro-psiquiat. (S. Paulo) 19:1-10, 1961.

[7] 7. DOIG, R. K. - Gastric biopsy and the investigation of the megaloblastic anaemias. Proc. roy. Soc. Med. 47:425-431, 1954.

[8] 8. DOIG, A., GIRDWOOD, R. H., DUTHIE, J. J. R., and KNOW, J. D. E. - Response of megaloblastic anaemia to prednisolone. Lancet, ii: 966-972, 1957.

[9] 9. FROST, J. W., and GOLDWEIN, M. I. - Observation on vitamin B₁₂ absorption in primary pernicious anemia during administration of adrenocortical steroids. New Engl. J. Med. 258:1096-1098, 1958.

[10] 10. FROST, J. W., GOLDWEIN, M. I., and KAUGMAN, B. D. - Studies of B₁₂ Co⁶⁰ absorption in malabsorption syndrome: results before and during specific therapy. Ann. intern. Med. 47:293-299, 1957.

[11] 11. GEIGER, W., and Fuhrmann, W. - Zur Differentialdiagnose der funikulären Spinalerkrankung. Nervenarzt, 24:290-298, 1953.

[12] 12. GÉLIN, G.; COI-RAULT, R., and HAMED, E. B. - Vitamine B₁₂ et syndromes neuro-anémiques. Ann. Méd. 53:172-216, 1952.

[13] 13. GLASS, G. B. J. - Biochemistry and physiology of Castle's intrinsic factor and its relationship to the metabolism of vitamin B₁₂ Rev. Hémat. 10:137-179, 1955.

[14] 14. GLASS, G. B. J. - Intestinal absorption and hepatic uptake of vitamin B₁₂ in diseases of the gastrointestinal tract. Gastroenterology, 30:37-52, 1956.

[15] 15. GLASS, G. B. J. - Gastric intrinsic factor and its function in the metabolism of vitamin B₁₂ Physiol. Rev. 43:529-849, 1963.

[16] 16. GORDIN, R. - Vitamin B₁₂ absortion in corticosteroid-treated pernicious anaemia. Acta. med. scand. 164:159-165, 1959.

[17] 17. HALVORSEN, S. - Effects of ACTH on erythropoiesis in rabbit. Acta physiol. scand. 58:30-39, 1963.

[18] 18. HSU, J. M., and CHOW, B. F. - Effect of pyridoxine deficiency on the absorption of vitamin B₁₂ Arch. Biochem. Biophys. 72:322-330, 1957.

[19] 19. JEWESBURY, E. C. - Subacute combined degeneration of the cord and achlorhydric peripheral neuropathies without anaemia. Lancet, ii: 307-312, 1954.

[20] 20. KOLB, L. C. - The relationship of the demyelinating diseases to allergic encephalomyelitis. Medicine, 29:99-121, 1950.

[21] 21. KRISTENSEN, H. P. O., and FRIIS, R. - Effect of prednisone on B₁₂ absorption in pernicious anemia. Acta med. scand. 166:249-254, 1960.

[22] 22. LAFON, R., PAGES, P., LABAUGE, R., and TEMPLE, J. P. - Le syndrome neuroanachlorhydrique: à propos de 31 observations. Rev. neurol. 91:321-329, 1954.

[23] 23. MINOT, G. R., and MURPHY, W. P. - Treatment of pernicious anemia by a special diet. J. Amer. med. Ass. 87:470-476, 1926.

[24] 24. MOLLIN, D. L., and ROSS, G. I. M. - Vitamin B₁₂, deficiency in the megaloblastic anemia. Proc. roy. Soc. Med. 47:428-431, 1954.

[25] 25. MURPHY, W. P., and HOWARD, I. - A comparison of the effect of vitamin B₁₂ with that of liver extract in the treatment of pernicious anemia during relapse and for maintenance. New Engl. J. Med. 247:838-840, 1952.

[26] 26. NAKAHARA, I., and SAKAMOTO, Y. - Studies on pyridoxine metabolism. VIII: The effect of adrenal and hypophyseal hormones on pyridoxine metabolism. J. Biochem. 52:358-362, 1962.

[27] 27. RICHMOND, J., and DAVIDSON, S. - Subacute combined degeneration of the spinal cord in non-addiso-nian megaloblastic anaemia. Quart. J. Med. 27:517-531, 1958.

[28] 28. ROGER, H. - Les syndromes neuro-anémiques. Marseille méd., 91:473-490, 1954.

[29] 29. SCHILLING, R. G. - Intrinsic factor studies. II: The effect of gastric juice on the urinary excretion of radioactivity after the oral administration of radioactive vitamin B₁₂ J. Lab. clin. Med. 42:860-866, 1953.

[30] 30. SIURALA, M., and TA WAST, M. - Neurological changes in idiopathic atrophic gastritis. Ann. Med. intern. Fenn. 44:13-24, 1955.

[31] 31. SPIES, T. D., LOPEZ, G. G., MILANÊS, F., ARAMBURU, T., and TOCA, R. L. - Association between gastric achlorhydria and subacute combined degene- ration of the spinal cord. Postgrad. Med. 4:89-95, 1948.

[32] 32. SPILLANE, J. D., and WELLS, C. E. C. - Nutritional disorders of the nervous system. In Elliott, K. A. C, Page, I. H. & Quastel, J. H.: Neurochemistry, 2nd ed. Charles C. Thomas, Springfield, 1962, pp. 930-953.

[33] 33. STEVENSON, T. D. - Response of megaloblastic anaemia to prednisolone. Lancet, i :48, 1958.

[34] 34. VICTOR, M., and LEAR, A. A. - Subacute combined degeneration of the spinal cord: current concepts of the disease process. Amer. J. Med. 20:896-911, 1956.

[35] 35. WINTROBE, M. M. - The search for an experimental counterpart of pernicious anemia. Arch, intern. Med. 100:862-869, 1957.

[36] 36. YEH, S. D., and CHOW, B. F. - Vitamin B₁₂ absorption in pyridoxine-deficient rats. Amer. J. clin. Nutr. 7:426-432, 1959.

[37] 37. ZEMAN, W., and DeLAND, F. H. - Contribution to the pathogenesis of subacute combined degeneration of the spinal cord: report of two cases. Amer. J. clin. Path. 28:515-523, 1957.

Brasil

Brasil

Efeito da corticotropina sobre a absorção de vitamina B12 na mielose funicular

Effect of corticotropin on the absorption of vitamin B12 in the subacute combined degeneration of the spinal cord

Resumos

Datas de Publicação