Diminished glucocorticoid negative feedback in polydipsic hyponatremic schizophrenic patients
Diminished glucocorticoid negative feedback in polydipsic hyponatremic schizophrenic patients
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DOI：
10.1210/jc.2006-1131
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发表时间：
2007-02-01
影响因子：
5.8
通讯作者：
Pilla, Ramani S.
中科院分区：
文献类型：
--
作者：
Goldman, Morris B.;Wood, Gordon;Pilla, Ramani S.
内容：糖皮质激素负反馈减少在精神分裂症中的机制和意义尚不清楚，但在原发性烦渴的精神分裂症患者中更常见。多饮患者，特别是那些同时患有低钠血症的患者，表现出与海马病理学相关的其他神经内分泌异常。目的：本研究的目的是在被认为对海马影响最敏感的条件下确定皮质醇对血浆ACTH的影响。设计：本设计是重复测量。设置：本研究在住院临床研究中心进行。参与者：参与者包括8例多饮性低钠血症和8例多饮性正常钠血症以及6例无水失衡的精神分裂症患者。干预措施：1430和1900 h口服甲吡酮（750 mg）。从19时30分开始，在150分钟内以0.03 mg/kg输注氢化可的松。H.血液样本和其他措施，获得在20分钟的时间间隔，从1850至2320 h。主要结果测量：血浆ACTH和皮质醇measured.Results：ACTH水平没有下降，在多饮低钠血症组的皮质醇输注显着。对于任何给定水平的皮质醇，ACTH水平在低钠血症组较高。虽然水平下降后，皮质醇在其他三个groups.Conclusions：在多饮性低钠血症精神分裂症患者的糖皮质激素负反馈的显着损害是一致的海马盐皮质激素功能障碍的患者水不平衡。
Context: The mechanism and significance of diminished glucocorticoid negative feedback in schizophrenia is unknown but is more commonly observed in schizophrenic patients with primary polydipsia. Polydipsic patients, especially those who are also hyponatremic, exhibit other neuroendocrine abnormalities that have been linked to hippocampal pathology.Objective: The objective of the study was to determine the effect of cortisol on plasma ACTH under conditions thought to be most sensitive to hippocampal influences.Design: The design was repeated measures.Setting: The study was conducted at an inpatient clinical research center.Participants: Participants included eight polydipsic hyponatremic and eight polydipsic normonatremic as well as six schizophrenic patients without water imbalance. Eight healthy community volunteers matched for age and gender were also studied.Intervention: Metyrapone ( 750 mg) was administered orally at 1430 and 1900 h. Beginning at 1930 h, hydrocortisone was infused over 150 min at 0.03 mg/kg . h. Blood samples and other measures were obtained at 20-min intervals from 1850 to 2320 h.Main Outcome Measures: Plasma ACTH and cortisol were measured.Results: ACTH levels did not decline significantly during the cortisol infusion in the polydipsic hyponatremic group. For any given level of cortisol, ACTH levels were higher in the hyponatremic group. Although levels declined after cortisol in the other three groups, the decline was greatest in patients without water imbalance.Conclusions: The marked impairment in glucocorticoid negative feedback in polydipsic hyponatremic schizophrenic patients is consistent with hippocampal mineralocorticoid dysfunction.