PITUITARY-ADRENAL RESPONSIVENESS TO CORTICOTROPIN-RELEASING HORMONE IN PATIENTS RECEIVING CHRONIC, ALTERNATE DAY GLUCOCORTICOID THERAPY
PITUITARY-ADRENAL RESPONSIVENESS TO CORTICOTROPIN-RELEASING HORMONE IN PATIENTS RECEIVING CHRONIC, ALTERNATE DAY GLUCOCORTICOID THERAPY
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DOI：
10.1210/jcem-61-1-22
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发表时间：
1985-01-01
影响因子：
5.8
通讯作者：
CHROUSOS, GP
中科院分区：
文献类型：
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作者：
SCHURMEYER, TH;TSOKOS, GC;CHROUSOS, GP
研究人员对 14 名患有系统性红斑狼疮的女性患者进行了垂体-肾上腺轴对绵羊促肾上腺皮质激素释放激素 (oCRH) 的反应性检查，这些女性接受了泼尼松的长期隔日糖皮质激素治疗。在服用类固醇当天（最后一次服药后 12 小时）和未服用糖皮质激素当天（最后一次服药后 36 小时）以随机顺序（2000 小时）进行两次测试。与正常受试者相比，血浆 ACTH 和皮质醇反应在治疗当天显着减弱，在治疗结束当天轻度减弱。外源性 oCRH 代谢清除率的改变并不是造成这种差异的原因，因为免疫反应性 oCRH 的血浆消失曲线在这两天相似。抑制程度取决于泼尼松的剂量； oCRH 测试期间分泌的皮质醇量与同时血浆 ACTH 水平的对数成正比。所有患者的皮质醇对 ACTH 的反应均正常。显然，在这两天的测试中，对 oCRH 的反应性减弱代表了泼尼松龙对促肾上腺皮质激素细胞的抑制。尽管如此，肾上腺仍然对 ACTH 保持正常的反应性，这表明每日 ACTH 分泌的适度减少与维持正常的肾上腺功能是相容的。因此，在长期、隔日使用糖皮质激素治疗期间，下丘脑-垂体-肾上腺轴轻度抑制的部位是中心部位。肾上腺的功能似乎不受影响。
The responsiveness of the pituitary-adrenal axis to ovine corticotropin-releasing hormone (oCRH) was examined in 14 women with systemic lupus erythematosus receiving chronic, alternate day glucocorticoid therapy with prednisone. Testing was done twice and in a random order (at 2000 h) on the day when the steroid was taken (12 h after the last dose) and on the day when no glucocorticoid was administered (36 h after the last dose). Plasma ACTH and cortisol responses were markedly blunted on the day of treatment and mildly blunted on the day off treatment compared to those in normal subjects. Altered metabolic clearance of exogenous oCRH was not responsible for this difference, since the plasma disappearance curves of immunoreactive oCRH were similar on both days. The degree of suppression was dependent on the dose of prednisone; the amount of cortisol secreted during the oCRH test was directly proportional to the logarithm of the concurrent plasma ACTH level. The cortisol response to ACTH was normal in all patients. Apparently, the blunting of responsiveness to oCRH on both days of testing represents prednisolone suppression of the corticotroph cell. Despite this, the adrenal glands retain normal responsiveness to ACTH, suggesting that moderate decreases in daily ACTH secretion are compatible with sustaining normal adrenal function. Hence, the site of the mild suppression of the hypothalamic-pituitary-adrenal axis during chronic, alternate day treatment with glucocorticoids is central; the adrenal glands appear to remain functionally unaffected.