快速ACTH刺激试验及其对女性多毛症的诊断价值

本研究以血皮质醇（Ｆ）、１７α－羟孕酮（１７αＯＨＰ）、脱氢表雄酮（ＤＨＥＡ）及睾酮（Ｔ）为指标，观察快速１一２４促肾上腺皮质激素（ＡＣＴＨ）刺激试验时正常妇女及女性多毛症病人，包括２１－羟化酶缺陷的先天性肾上腺皮质增生症（ＣＡＨ）、多囊卵巢综合征（ＰＣＯＳ）、特发性多毛症（ＩＨ）及迟发型ＣＡＨ（ＬＯＡＨ）等对１一２４ＡＣＴＨ的反应。１０名正常妇女静注１－２４ＡＣＴＨ２５０ｕｇ后，血Ｆ、ＤＨＥＡ、１７α－ＯＨＰ明显升高，血Ｔ对１－２４ＡＣＴＨ刺激无反应。６例ＣＡＨ病人血１７αＯＨＰ及ＤＨＥＡ基础值均较正常人明显增高（Ｐ＜０００１）。２０例ＰＣＯｓ及１１例ＩＨ病人血１７αＯＨＰ基础值较正常女性为高（Ｐ＜０．０５）。１－２４ＡＣＴＨ刺激后，血１７αＯＨＰ净增值（△１７αＯＨＰ）与正常女性无明显差别（Ｐ＞０．０５）。２例ＬＯＡＨ病人血１７αＯＨＰ基础值较高，刺激后有效大幅度升高，呈高反应。根据以上结果，我们认为，以１７αＯＨＰ为指标进行快速１－２４ＡＣＴＨ刺激试验有助于鉴别各种原因的女性多毛

Rapid ACTH stimulation test and it’s diagnostic value in hirsutism

The responses to rapid ACTH stimulation test(250μg 1-24ACTH i.v.bolus) in normalwomen and women with hirsutism were observed with measurement of serum cortisol(F)17αhydroxyprogesterone(17α OHP),dehydroepiandrosterone(DHEA) and testosterone(T).In 10 normalwomen,serum F,DHEA and 17α OHP levels increased markedly to1-24ACTH stimulation.NO res-ponse of serum T was found to 1-24ACTH stimulation.In 6 congenital adrenal hyperplasia(CAH) pa-tients,basal serum levels of DHEA and 17αOHP were much higher than normals(P<0.00 1). 20 cases ofpolycystic ovary syndrome(PCOS)and 11 cases of idiopathic hirsutism(IH) had higher basal and stimu-lated values of serum 17αOHP than normal females(P<0.05),but △17αOHP were not different fromnormals(P>0.05).In two cases of late onset congenital adrenal hyperplasia(LOAH),the basal serum17αOHP levels were higher,stimulated levels of 17αOHP were much higher than normals(P<0.00 1).Measuring the serum 17αOHP in rapid ACTH stimulation test is highly valuable to distinguish hirsutismof various causes.