RE‐EVALUATION OF THE CLINICAL VALUE OF THE 30 MIN ACTH TEST IN ASSESSING THE HYPOTHALAMIC‐PITUITARY‐ADRENOCORTICAL FUNCTION
RE‐EVALUATION OF THE CLINICAL VALUE OF THE 30 MIN ACTH TEST IN ASSESSING THE HYPOTHALAMIC‐PITUITARY‐ADRENOCORTICAL FUNCTION
复制标题
重新评估 30 分钟 ACTH 测试评估下丘脑-垂体-肾上腺皮质功能的临床价值
作者：
J. Lindholm;H. Kehlet
胰岛素低血糖试验已广泛用于评估下丘脑-垂体-肾上腺皮质功能。在200例确诊或疑似下丘脑-垂体疾病的连续患者中，将该试验的结果与30分钟ACTH试验的结果进行了比较。在血糖水平降至2.2 mmol/l（40 mg/dl）或以下的患者中，低血糖期间血浆皮质醇浓度峰值与ACTH后30分钟血浆皮质醇浓度之间的比值为1.002。在血糖浓度降至2.3-30 mmol/l（41-54 mg/dl）的患者中，该比率显着降低（0.828）。在8例患者中，发现两种试验结果不一致，在2例患者中，ACTH试验正常，尽管对胰岛素的反应受损。他们研究后不久，急性症状的垂体腺瘤坏死。2例患者对胰岛素的反应低于正常，尽管垂体-肾上腺功能似乎完好无损。在这两种情况下，低血糖刺激的相对不足是差异的可能原因。在其余4例患者中，一项试验的结果略低于正常下限，另一项试验的结果略高于正常下限。可以得出结论，30分钟ACTH试验对于评估下丘脑-垂体-肾上腺综合功能是可靠的（急性ACTH剥夺后不久除外）。
The insulin hypoglycaemia test has been widely used for assessing the hypothalamic‐pituitary‐adrenocortical function. The outcome of this test has been compared to that of the 30 min ACTH test in 200 consecutive patients with proven or suspected hypothalamic‐pituitary disorder. A significant correlation (R= 0.83, P < 0.001) between the results of the two tests was found. In patients in whom blood glucose levels fell to 2.2 mmol/l (40 mg/dl) or below, the ratio between the peak plasma Cortisol concentration during hypoglycaemia and plasma Cortisol concentration 30 min after ACTH was 1.002. In patients in whom blood glucose concentration declined to 2.3–30 mmol/l (41–54 mg/dl) the ratio was significantly lower (0.828). In eight patients discordant results between the two tests were found. In two patients the ACTH test was normal despite impaired response to insulin. They were studied shortly after acute symptoms of a pituitary adenoma necrosis. Two patients had subnormal responses to insulin despite the fact that pituitary‐adrenal function appeared to be intact. In both cases relative insufficiency of the hypoglycaemic stimulus was the likely cause of the discrepancy. In the remaining four patients results of one test was marginally below, and that of the other test marginally above the lower limit of normal. It is concluded that the 30 min ACTH test is reliable for assessing integrated hypothalamic‐pituitary‐adrenal function (except shortly after acute ACTH deprivation).
使用地塞米松-促肾上腺皮质激素测试来评估垂体手术后是否需要继续糖皮质激素替代治疗。
DOI：
10.1210/jcem-60-5-1012
发表时间：
1985
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
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作者：
Beyer,HS;Bantle,JP;Mariash,CN;Steffes,MW;Seljeskog,EL;Oppenheimer,JH
通讯作者：
Oppenheimer,JH