ADRENOCORTICOTROPHIN (ACTH) DEFICIENCY UNDETECTED BY STANDARD DYNAMIC TESTS OF THE HYPOTHALAMIC‐PITUITARY‐ADRENAL AXIS
ADRENOCORTICOTROPHIN (ACTH) DEFICIENCY UNDETECTED BY STANDARD DYNAMIC TESTS OF THE HYPOTHALAMIC‐PITUITARY‐ADRENAL AXIS
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下丘脑-垂体-肾上腺轴的标准动态测试未检测到肾上腺皮质激素（ACTH）缺乏
DOI：
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发表时间：
1988
影响因子：
3.2
通讯作者：
E. L. Robinson
中科院分区：
文献类型：
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作者：
A. Tsatsoulis;S. Shalet;J. Harrison;W. Ratcliffe;C. Beardwell;E. L. Robinson
六名患者（四名女性，两名男性;年龄18-65岁），既往接受过垂体外照射治疗（2000-4000 cGY，8-15次，10-20天）用于垂体瘤，表现为过度和不适当的疲劳症状，提示ACTH缺乏，尽管对胰岛素耐量试验（4例）或胰高血糖素刺激试验（2例）的皮质醇反应峰值正常。6例患者24小时尿游离皮质醇水平（100 ± 40 nmol，均数±标准差）显著低于31例正常对照组（210 ± 70.8 nmol，P<0.01）。此外，基于0900-2300 h之间的一系列四个定时样本的血清皮质醇曲线低于正常值（平均130 nmol/l），与12个正常对照组（平均270 nmol/l）相比（P <0.001）。糖皮质激素替代治疗迅速消除了他们的症状。这些结果表明，在ACTH缺乏症患者中，可能存在基础情况下ACTH分泌与ACTH对药理学试验的反应之间的不一致性。我们推测，由于下丘脑水平的辐射诱导损伤导致的内源性促肾上腺皮质激素释放激素（CRF）分泌缺陷是这种现象的原因之一。
Six patients (four females, two males; aged 18–65 years), previously treated by external pituitary irradiation (2000–4000 cGY in 8–15 fractions over 10–20 days) for pituitary tumours, presented with the symptoms of excessive and inappropriate tiredness suggestive of ACTH deficiency, despite a normal peak cortisol response to an insulin tolerance test (four cases) or to a glucagon stimulation test (two cases). These six patients were found to have significantly lower mean 24 h urinary free cortisol levels (100 ± 40 nmol; mean ± SD) compared with the mean value of 31 normal controls (210 ± 70.8 nmol; P<0.01). In addition serum cortisol profiles based on a series of four timed samples between 0900–2300 h were subnormal (mean 130 nmol/l) in comparison with profiles obtained from 12 normal controls (mean 270 nmol/l) (P <0.001). Glucocorticoid replacement therapy promptly abolished their symptoms. These results suggest that a discordance between ACTH secretion under basal circumstances and ACTH response to pharmacological tests may exist in patients with ACTH deficiency. We speculate that defective endogenous corticotrophin‐releasing hormone (CRF) secretion, due to radiation‐induced damage at hypothalamic level, is one cause of this phenomenon.
未提取的人血浆中促肾上腺皮质激素的快速放射免疫测定。
影响因子：
9.3
作者：
Nicholson,WE;Davis,DR;Sherrell,BJ;Orth,DN
通讯作者：
Orth,DN