肾上腺皮质功能减退时垂体-肾上腺皮质激素的改变

THE CHANGES IN PLASMA ACTH, SERUM CORTISOL AND UFC IN PATIENTS WITH ADRENAL INSUFFICIENCY

为评估血浆ACTH、血清皮质醇、尿游离皮质醇 (UFC)水平及垂体和肾上腺皮质储备功能试验对原发性和继发性肾上腺皮质功能减退症的诊断和鉴别诊断价值 ,回顾性分析了 16例已确诊为Addison病和 75例垂体或下丘脑功能减退患者的血浆ACTH、血清皮质醇和UFC水平的改变 ,以及ACTH刺激试验、胰岛素低血糖刺激试验和氨基导眠能试验的特点。结果显示 ,原发性肾上腺皮质功能减退病人血浆ACTH水平普遍显著升高 ,血清皮质醇和UFC绝大多数患者降低 ,但少数病人正常 ,且对ACTH刺激试验无反应。继发性肾上腺皮质功能减退患者多数人血浆ACTH正常 ,而血清皮质醇和 (或 )UFC降低 ,他们对胰岛素低血糖试验或氨基导眠能试验无反应 ,对ACTH刺激试验呈延迟或正常反应。结果表明 ,皮质醇和UFC水平降低是绝大多数肾上腺皮质功能减退症病人的特征。ACTH水平是鉴别原发性或继发性肾上腺皮质功能减退的关键 ,原发性者ACTH水平升高 ,继发性者ACTH水平不高。ACTH刺激试验是诊断原发性肾上腺皮质功能减退症的有用工具 。

To evaluate the significance of plasma ACTH, serum cortisol and UFC levels as well as ACTH stimulation test, aminoglutethimide test and insulin induced hypoglycemia test in patients with adrenal insufficiency. Sixteen patients with primary insufficiency (Addison`s disease) and 75 cases with secondary insufficiency (hypopituitarism) diagnosed from 1985 to 1999 were reviewed. It was found that high levels of ACTH were detected in all patients with primary insufficiency, and in most of them the levels of cortisol and UFC were low. No response of cortisol and UFC were observed after ACTH stimulation in the patients with primary insufficiency, but normal or delayed action was observed in the patients with secondary adrenal insufficiency. In most of secondary adrenal insufficiency the ACTH levels were in normal range but the cortisol and UFC levels were low; the elevated action of ACTH by insulin induced hypoglycemia test or aminoglutethimide test did not appear in the patients with secondary adrenal insufficiency. The results suggested that the low levels of cortisol and UFC were a common feature in the most of patients both with primary or secondary adrenal insufficiency. The ACTH level was the key indicator to distinguish the primary adrenal insufficiency from secondary adrenal insufficiency, as the ACTH levels were remarkably elevated in primary patients but were normal or decreased in secondary insufficiency patients. The ACTH stimulation test was useful in the diagnosis of the primary or secondary adrenal insufficiency. The insulin induced hypoglycemia test or aminoglutethimide test was valuable in the diagnosis of the secondary adrenal insufficiency.