Dissociation of adrenal androgen and cortisol levels in acute stress.
Dissociation of adrenal androgen and cortisol levels in acute stress.
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急性应激时肾上腺雄激素和皮质醇水平的分离。
DOI：
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发表时间：
1985
期刊：
影响因子：
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通讯作者：
G. Juler
中科院分区：
文献类型：
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作者：
L. Parker;J. Eugene;D. Farber;E. Lifrak;M. Lai;G. Juler
从急性手术应激中恢复的患者通常会排出更多的 17-OH 皮质类固醇，而 17-酮类固醇没有变化。对这些发现的解释尚不清楚。为了研究急性应激时皮质醇和肾上腺雄激素代谢之间可能存在的差异，在术前 48 至 96 小时接受 ACTH 刺激的患者中重复进行早晨皮质醇和脱氢表雄酮 (DHA) 测量，然后在大手术之前和期间进行测定，也在早上进行。皮质醇和 DHA 大部分由肝脏代谢，因此在已知不会影响皮质醇代谢的恒定全身麻醉方案下，通过术前和术中吲哚菁绿染料清除率来监测肝脏血流量。结果表明，两小时的 ACTH 刺激或大手术所产生的皮质醇和 DHA 刺激之间没有差异，全身麻醉期间肝血流量略有下降 (14.4%)。然而，虽然 DHA 浓度在手术前保持恒定，但皮质醇浓度增加了 61%（P 小于 0.05）。先前的研究还表明，手术前皮质醇浓度会升高，这可能是由于心理压力所致。然而，这是首次证明由于心理压力，皮质醇浓度与肾上腺雄激素之间存在分离。
Patients recovering from acute surgical stress often excrete increased 17-OH corticosteroids with no change in 17-ketosteroids. The explanation for these findings is unclear. In order to investigate possible divergence between cortisol and adrenal androgen metabolism in acute stress, repeated morning cortisol and dehydroepiandrosterone (DHA) measurements were made in patients undergoing ACTH stimulation 48 to 96 hours preoperatively, followed by determinations before and during major surgery, also performed in the morning. Cortisol and DHA are largely metabolized by the liver, so liver blood flow under a constant general anesthetic regimen known not to affect cortisol metabolism was monitored by pre- and intraoperative indocyanine green dye clearance. Results indicated no difference between the cortisol and DHA stimulation resulting from two hours of ACTH stimulation or major surgery, and a small (14.4%) decline in hepatic blood flow during general anesthesia. However, while DHA concentrations remained constant immediately preceding surgery, cortisol concentrations increased by 61% (P less than 0.05). Previous studies have also demonstrated increased concentrations of cortisol before surgical procedures, presumably due to psychological stress. However, this is the first demonstration of a dissociation between concentrations of cortisol and an adrenal androgen due to psychological stress.