Urinary urgency induced by thyrotropin-releasing hormone

153

P~yhiarry Research, 8, 153- I57 ( 1983) Elsevier Biomedical Press

Letters Urinary Urgency Induced by Thyrotropin-Releasing Hormone pine had no effect on the subjective sensations including urinary urgency in the volunteers. A few subjects were embarrassed by urinary urgency and some reported it only when questioned. The higher incidence (95.5%) of urinary urgency in our study compared to previous reports is unlikely to be a phenomenon of suggestion as observed by Hall et al. (Almquist, 1972). Based on our limited data, it does not seem to be related to age, sex, or psychiatric illness. The higher dose of TRH that we used may account for its increased incidence because Almquist reports only a 34.2% incidence of urinary urgency with 200 ,ug of TRH and no side effects with 20 to 60 pg. Regarding the mechanisms of TRH-induced urinary urgency, Rosenthal ( 1974) has documented the phenomenon in a patient with a complete spinal cord transection, supporting a central effect. Earlier in vitro studies (Almquist, 1972) suggested a local action of TRH on bladder muscle. Our study suggests that this effect may not be mediated through the cholinergic system

Although thyrotropin-releasing hormone (TRH) tests are extensively used, very little attention is paid to the known transient subjective side effects of TRH. We investigated the occurrence of TRH-induced urinary urgency in 6 healthy male volunteers and 16 drug-free psychiatric patients (4 men, 12 women; aged 18-37 years) with the diagnosis of major depression or borderline personality disorder. We also examined the effects of atropine sulphate (0.5 mg i.v.) injected 30 minutes before TRH on the urinary urgency induced by TRH in the volunteers. TRH tests (500 pg i.v.) were performed in every subject on two different occasions with an interval of at least 4 days. Every participant was asked to void before the test. Subjective side effects of TRH (Table I) were reported between 25 and 60 seconds during the injection. Urinary urgency persisted from a few to several seconds, and other effects generally lasted from 30 seconds to 3 minutes. Only one male patient with a borderline personality diagnosis denied experiencing urinary urgency. Atro-

Table 1. Subjective

side effects of TRH No. of persons experiencing side effects

Side

effects

Urinary

urgency

Volunteers (n = 6)

Patients (n = 16)

(n = 22)

Percentage

6

15

21

95.5

Total

Feelings 4

7

11

50.0

Nausea

-

4

4

19.0

Taste

2

2

4

19.0

3

3

13.6

2

2

9.5 -

of flushing

Dizziness Epigastric discomfort Other effects

0165-1781)

83, 0000-0000;

-

$3.00 e Elsevier Science

-

Publishers

B.V.. Amsterdam

154

since atropine did not prevent its occurrence. We have also observed (Nathan, Sachar, Tabrizi, unpublished data) that TRH-induced urinary urgency is not prevented by cyproheptadine (an antiserotonergic drug) in four healthy men, suggesting an absence of serotonergic influence. Although inconclusive, in the absence of serotonergic and cholinergic neurotransmitter involvement, our data seem to favor a direct central site of action for TRH-induced urinary urgency. Our observations may have research implications in the study of knuresis. It will be of interest to assess whether increased secretion of endogenous TRH at night could lead to enuresis in susceptible children.

and Anselm George, M.D., for their assistance and the volunteers and patients for their participation in the study.

This study was supported by MHCRC Grant 30915. Theauthor is grateful to Theresa McCarthy, R.N., Jeffrey Peters, M.D., Paul H. Soloff, M.D.,

(1972). _I Rosenthal, M.B. TRH and urinary urgency. New England Journal of Medicine. 291, 1308 (1974).

Acknowledgment.

R. Swami

Nathan,

M.D.

Department of Psychiatry University of Pittsburgh School of Medicine Pittsburgh, PA 15213 USA September

16, 1982

References Almquist, Frontiers

S. Clinical side effects of TRH. of Hormone

Research.

1. 38