The occurrence of serotonin in the human adrenal gland was demonstrated both by immuno-histochemical and biochemical approaches. Using specific polyclonal antibodies to serotonin, the presence of numerous immunoreactive cells was revealed by means of the peroxidase-antiperoxidase technique. These cells exhibited the morphological characteristics of mast cells. Combination of high performance liquid chromatography and electrochemical detection showed the presence of substantial amounts of both serotonin and its metabolite 5-hydroxyindolacetic acid in adrenocortical extracts. The role of serotonin in the regulation of steroidogenesis from human adrenocortical slices was studied in vitro using a perifusion system technique coupled to a specific radioimmunoassay for cortisol. Graded doses of serotonin (from 10⁻⁸M to 3 × 10⁻⁷M) increased cortisol production in a dose-dependent manner. Prolonged exposure of adrenal fragments to serotonin (10⁻⁷ M) induced a biphasic response, i.e. a rapid and transient increase in cortisol secretion followed by a plateau phase, suggesting the existence of a desensitization phenomenon. The stimulatory effect of serotonin (10⁻⁷M) was not altered during infusion of the serotonin, and/or serotonin₂ receptor antagonists methysergide (10⁻⁶ M) and ketanserin (10⁻⁶ M), respectively. In contrast, ICS 205 930 (10⁻⁶ M), a non-selective serotonin₃/serotonin₄ antagonist, totally abolished the response of adrenal slices to serotonin (10^t7¯ M). The benzamide derivative zacopride, considered as a serotonin₄ agonist, induced a robust stimulation of cortisol secretion. In addition, the corticotropic effects of serotonin (10⁻⁷ M) and zacopride (10⁻⁶ M) were not additive. Incubation of adrenocortical fragments with zacopride (10⁻⁶ M) or serotonin (10⁻⁶ M) caused a significant increase in cAMP formation.

Taken together, these data suggest that serotonin, locally released by intra-adrenal mast-like cells, may act as a paracrine factor to stimulate cortisol secretion in man. Our results also indicate that serotonin-induced corticosteroid production is mediated through activation of a serotonin₄ receptor subtype positively coupled to adenylate cyclase.