Combined amplification of the pulsatile and basal modes of adrenocorticotropin and cortisol secretion in patients with Cushing's disease: evidence for decreased responsiveness of the adrenal glands.
Combined amplification of the pulsatile and basal modes of adrenocorticotropin and cortisol secretion in patients with Cushing's disease: evidence for decreased responsiveness of the adrenal glands.
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库欣病患者促肾上腺皮质激素和皮质醇分泌的脉动和基础模式的联合放大：肾上腺反应性下降的证据。
DOI：
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发表时间：
1995
影响因子：
5.8
通讯作者：
F. Roelfsema
中科院分区：
文献类型：
--
作者：
G. V. D. Berg;Marijke Frölich;J. D. Veldhuis;F. Roelfsema
我们研究了16例库欣病患者和23名健康对照者的24小时ACTH和皮质醇分泌谱。每隔10分钟采集一次血液样本，并用多参数反褶积技术分析数据。患者每24小时ACTH脉冲数与对照组相同（34 vs. 32/24 h），血浆ACTH半衰期相似（17.4 +/- 0.7 vs. 19.3 +/- 0.5 min）。单脉冲促肾上腺皮质激素分泌量增加，主要是由于最大分泌速率增加和分泌爆发持续时间延长所致。溶解的皮质醇脉冲数少于ACTH，但患者高于对照组（24 vs 17/24 h），两组的半衰期相似（57 +/- 2 vs 59 +/- 4 min）。患者每次脉冲分泌的皮质醇质量高于对照组，这是由于每次脉冲内达到的最大分泌率增加。对照组24小时皮质醇生成的平均总质量为12.8 mg（范围6.7-20 mg），患者为46 mg（范围13.4-154 mg）。库欣病患者ACTH和皮质醇的基础分泌率分别比对照组高19倍（ACTH）和7倍（皮质醇）（P < 0.0002）。24小时总皮质醇和ACTH的比值（以每L分布体积的质量单位计算）在对照组为23 +/- 1.9，在患者为11 +/- 2.3 （P < 0.001）。ACTH分泌参数在对照组中表现出较强的昼夜节律，但在6例患者中无显著性差异。皮质醇的昼夜节律只能在5名患者中检测到。根据这些观察结果，我们得出结论，库欣病的皮质醇和ACTH释放具有高度脉动性，仅在一些患者中保留了昼夜特性。库欣病每日激素分泌总量的显著增加归因于19倍（ACTH）和7倍（皮质醇）较高的基础分泌率、增加的分泌破裂团（ACTH和皮质醇）和频率（皮质醇）。此外，肾上腺对ACTH水平升高的明显反应减弱，提示肾上腺的反应性降低。
We investigated 24-h ACTH and cortisol secretory profiles in 16 patients with Cushing's disease and 23 healthy controls. Blood samples were taken at 10-min intervals, and data were analyzed with a multiparameter deconvolution technique. The patients had the same number of ACTH pulses per 24 h as the controls (34 vs. 32/24 h) and similar plasma ACTH half-lives (17.4 +/- 0.7 vs. 19.3 +/- 0.5 min). The mass of ACTH secreted per pulse was increased, which was caused by an increased maximal secretion rate and prolonged secretion burst duration. The number of resolved cortisol pulses was less than that for ACTH, but higher in patients than in controls (24 vs. 17/24 h), with similar half-lives in both groups (57 +/- 2 vs. 59 +/- 4 min). The mass of cortisol secreted per pulse was higher in patients than in controls due to an increased maximal secretion rate attained within each burst. The mean total mass of 24-h cortisol production was 12.8 mg in controls (range, 6.7-20 mg) and 46 mg (range, 13.4-154) in patients. Basal secretion rates of ACTH and cortisol were increased 19-fold (ACTH) and 7-fold (cortisol) above control values in patients with Cushing's disease (P < 0.0002). The ratio of total 24-h cortisol and ACTH production (in mass units per L distribution volume) was 23 +/- 1.9 in controls and 11 +/- 2.3 in patients (P < 0.001). The secretory parameters for ACTH showed strong diurnal rhythms in control subjects, but were not significant in six patients. Diurnal rhythms for cortisol could be detected in only five patients. From these observations we conclude that cortisol and ACTH release in Cushing's disease is highly pulsatile, with the preservation of diurnal properties in only some patients. Markedly amplified total daily hormone secretion was attributed to a 19-fold (ACTH) and 7-fold (cortisol) higher basal secretion rate, increased secretory burst mass (ACTH and cortisol), and frequency (cortisol) in Cushing's disease. In addition, the apparent response of the adrenal gland to increased ACTH levels is diminished, suggesting decreased responsiveness of the adrenal glands.
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DOI：
10.1210/jcem-64-5-1027
发表时间：
1987
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
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DOI：
10.1530/acta.0.1280521
发表时间：
1993
期刊：
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影响因子：
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DOI：
10.1210/jcem.77.1.8392084
发表时间：
1993
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Roelfsema,F;vandenBerg,G;Frolich,M;Veldhuis,JD;vanEijk,A;Buurman,MM;Etman,BH
通讯作者：
Etman,BH
影响因子：
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作者：
VELDHUIS, JD;IRANMANESH, A;JOHNSON, ML
通讯作者：
JOHNSON, ML
DOI：
10.1210/jcem.75.5.1358909
发表时间：
1992-11
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
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作者：
B. Biller;J. Alexander;N. Zervas;E. Hedley‐Whyte;A. Arnold;A. Klibanski
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B. Biller;J. Alexander;N. Zervas;E. Hedley‐Whyte;A. Arnold;A. Klibanski