ABNORMAL CORTISOL SECRETION AND RESPONSES TO CORTICOTROPIN-RELEASING HORMONE IN WOMEN WITH HYPOTHALAMIC AMENORRHEA
ABNORMAL CORTISOL SECRETION AND RESPONSES TO CORTICOTROPIN-RELEASING HORMONE IN WOMEN WITH HYPOTHALAMIC AMENORRHEA
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DOI：
10.1210/jcem-70-2-311
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发表时间：
1990-02-01
影响因子：
5.8
通讯作者：
KLIBANSKI, A
中科院分区：
文献类型：
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作者：
BILLER, BMK;FEDEROFF, HJ;KLIBANSKI, A
下丘脑性闭经（HA）是一种常见的与低雌激素血症相关的疾病，并具有不良反应。这些妇女中GnRH缺乏的机制尚不清楚。为了研究下丘脑-垂体-肾上腺轴在HA中的作用，我们研究了10名女性[平均年龄，29岁± 10岁]。7（.+-. SD）年]，闭经时间为0.5-13年（平均4.3 ± 1.5年）。3.7与单纯的体重减轻或心理压力有关。我们研究了皮质醇和促肾上腺皮质激素的反应，绵羊CRH，24小时血浆皮质醇水平，每10分钟获得，尿游离皮质醇水平在这些患者。结果进行了比较，在月经周期的各个阶段中获得的正常妇女。我们发现HA患者的皮质醇平均基础浓度显著较高（P = 0.03）（平均210 ± 0.001）。130 nmol/L）比正常妇女（100 . ±. 30 nmol/L）。Δ(peak- 基础）皮质醇在HA患者中显著低于（P = 0.004）正常妇女（320 ± 0.001）。100对440 +-。90 nmol/L）。ACTH对CRH的反应在HA患者和正常女性之间没有差异。HA患者的24小时平均皮质醇显著高于正常对照组（P = 0.006）（280 ± 0.01）。50和220 .+-. 50 nmol/L），由于夜间皮质醇水平较高。尿游离皮质醇水平在HA患者中显著较高（P = 0.005）（230 ± 0.001）。70 nmol/天）比正常妇女（150 nmol/天）高。40 nmol/天）。我们的结论是，妇女与HA有一个钝皮质醇反应CRH管理。此外，他们有皮质醇增多症，表现为升高的24小时平均血清皮质醇水平和尿游离皮质醇值。应激或体重减轻患者的下丘脑-垂体-肾上腺轴激活可能是闭经发生的机制，并可能与HA的其他潜在不良反应有关。
Hypothalamic amenorrhea (HA) is a common disorder associated with hypoestrogenemia and has adverse effects. The mechanism of GnRH deficiency in these women is not yet known. To investigate the role of the hypothalamic-pituitary-adrenal axis in HA, we studied 10 women [mean age, 29 .+-. 7 (.+-. SD) yr] with 0.5-13 yr of amenorrhea (mean, 4.3 .+-. 3.7 yr) related to simple weight loss or psychological stress. We investigated cortisol and ACTH responses to a bolus of ovine CRH, 24-h plasma cortisol levels obtained every 10 min, and urinary free cortisol levels in these patients. Results were compared with those obtained in normal women during all phases of the menstrual cycle. We found that mean basal concentrations of cortisol were significantly higher (P = 0.03) in the HA patients (mean, 210 .+-. 130 nmol/L) than in the normal women (100 .+-. 30 nmol/L). The .DELTA. (peak - basal) cortisol was significantly lower (P = 0.004) in the HA patients than in the normal women (320 .+-. 100 vs. 440 .+-. 90 nmol/L, respectively). ACTH responses to CRH did not differ between HA patients and normal women. The 24-h mean cortisol was significantly higher (P = 0.006) in the HA patients than in the normal controls (280 .+-. 50 and 220 .+-. 50 nmol/L, respectively), due to higher cortisol levels at night. The urinary free cortisol level was significantly higher (P = 0.005) in the HA patients (230 .+-. 70 nmol/day) than in normal women (150 .+-. 40 nmol/day). We conclude that women with HA have a blunted cortisol response to CRH administration. In addition, they have hypercortisolism, as demonstrated by elevated 24-h mean serum cortisol levels and urinary free cortisol values. This hypothalamic-pituitary-adrenal axis activation in patients with stress or weight loss may be a mechanism in the development of amenorrhea and may relate to other potential adverse effects of HA.