重型颅脑创伤患者血清COR、ACTH及血糖的变化

目的评估重型颅脑创伤患者伤后不同时期的血清皮质醇(COR)、促肾上腺皮质激素(ACTH)及血糖水平的变化,及其在伤情判断与预后中的作用。方法前瞻性选择重型颅脑创伤患者56例,正常对照组23例,重型颅脑创伤患者按入院时GCS评分分为重型组(6～8分)、特重型组(3～5分)两个亚组,治疗4个月后对比预后评分(GOS评分),测定不同时期血清COR、ACTH及血糖浓度。结果 GCS 3～5分与6～8分组血清COR、ACTH及血糖浓度入院后5 d内均显著增高,与对照组比较差异有显著性(P<0.01),GCS 3～5分组血清COR、ACTH、血糖浓度高于GCS 6～8分组(P<0.05)。GCS 3～5分组死亡率明显高于6～8分组,颅脑损伤组第1 d血清COR、ACTH、血糖浓度均显著高于对照组(P<0.01)。结论重型颅脑创伤患者伤后血清COR、ACTH及血糖均有不同程度的增高,监测血清COR、ACTH及血糖浓度可作为判断患者病情轻重、治疗效果和预后的一项重要指标。     

高海拔地区重型颅脑损伤血清FSH、LH、PRL的变化

目的 探讨高海拔地区重型颅脑损伤内分泌激素水平的变化规律,为提高高海拔地区重型颅脑损伤的治疗效果提供帮助。方法 2012年1月至2013年12月收治高海拔地区颅脑损伤120例,其中重型颅脑损伤（入院时GCS评分3~8分）60例,轻型颅脑损伤（入院时GCS评分13~15分）60例。伤后1、3、7、14、21 d应用放射免疫定量分析法检测血清促卵泡生长素（FSH）、促黄体生成素（LH）、催乳素（PRL）水平。结果 伤后1、3、7、14、21 d,重型颅脑损伤血清FSH、LH水平与与轻型颅脑损伤相比无显著性变化（P>0.05）;而PRL水平在伤后1 d有显著变化（P <0.05）,以后无显著性差异（P>0.05）。结论 高海拔地区重型颅脑损伤血清PRL有轻微变化,而血清FSH、LH的水平无显著性变化。     

急性脑血管病患者下丘脑—垂体—肾上腺皮质轴与性腺轴功能研究

急性脑血管病(ACVD)患者的PRL、GH、ACTH、LH、FSH及F水平均显著高于对照组;ACVD并发多器官功能衰竭(MOF)患者,除LH外,余5种激素水平显著高于ACVD各疾病组;随ACVD病程不同,9种激素水平也相应改变,1周时水平最高,2周后逐渐恢复;ACVD并发MOF重型患者(MOF积分>4分)PRL、GH、F水平显著高于轻型患者(MOF积分≤4分)。结果提示PRL、GH和F可能参与ACVD并发MOF的病理生理过程。     

急性颅脑损伤外周血垂体前叶激素及脑脊液硫化氢水平变化

目的探讨外周血垂体前叶激素、脑脊液硫化氢(H2S)水平与急性颅脑损伤病情的关系。方法 2014年3月至2015年11月收治急性颅脑损伤90例,根据入院时GCS评分分为轻型组(GCS评分13~15分)、中型组(GCS评分9~12分)及重型组(GCS评分3~8分),各30例。伤后1 d采集空腹静脉血测定促甲状腺激素(TSH)、泌乳素(PRL)、黄体生成素(LH)、促卵泡激素(FSH)、生长激素(GH),另外测定脑脊液H_2S水平。结果外周血GH、PRL水平以及脑脊液H_2S水平随颅脑损伤程度加重明显增高(P0.05),而外周血TSH、LH、FSH与颅脑损伤程度无明显相关性(P0.05)。结论外周血GH、PRL及脑脊液H_2S水平可作为评估急性颅脑损伤病情的指标。     

急性颅脑损伤后垂体激素变化规律探讨

目的：探讨急性颅脑损伤患者垂体激素水平的变化及与颅脑损伤程度的相关性。方法随机抽取60例颅脑损伤患者作为观察组（损伤程度采用GCS评分评估）,15例志愿者为对照组,采用酶联免疫定量分析法检测伤后1、3、7、30d血清催乳素（PRL）、卵泡刺激素（FSH）、黄体生成激素（LH）和促甲状腺激素（TSH）水平。结果观察组伤后血清PRL、FSH、LH显著升高（P＜0.05）,TSH略降低（P＞0.05）;观察组血清PRL、FSH、LH水平早期升高明显（72h内尤为明显）,后逐渐降低。颅脑损伤越重,PRL、FSH、LH值早期越高。结论急性颅脑损伤垂体激素PRL、FSH及LH水平于伤后早期明显升高,TSH稍降低,变化程度与颅脑损伤严重程度有关。     

急性颅脑损伤后垂体前叶激素的动态变化及意义

目的探讨急性颅脑损伤患者垂体前叶激素水平的变化与颅脑损伤程度及预后的关系。方法随机抽取90例颅脑损伤患者作为观察组,采用酶联免疫定量分析法动态检测伤后第1、3、5、7、14、30d血清催乳素(PRL)、卵泡刺激素(FSH)、黄体生成激素(LH)和促甲状腺激素(TSH)水平;30例正常人作对照组,损伤程度采用GCS评分评估,预后采用GOS评分评估。结果观察组血清PRL、FSH、LH较对照组显著升高(P<0.05),TSH较对照组略降低(P>0.05);观察组血清PRL、FSH、LH水平伤后升高(72h内尤为明显),后逐渐降低,血清TSH的水平伤后略降低,后逐渐回升;GCS评分较低者垂体前叶激素变化幅度较大;预后恶劣的颅脑损伤患者垂体前叶激素变化幅度较大。结论急性颅脑损伤后血清垂体前叶激素PRL、FSH及LH水平明显升高,变化程度与颅脑损伤严重程度及预后有关。     

垂体腺瘤类型与患者性别、年龄的关系

对781例不同激素类型垂体腺瘤分析发现,无激素型腺瘤最常见(28.68％),其次是PRL腺瘤(26.12％),多激素腺瘤(17.67％),FSH、LH腺瘤(15.62％),GH腺瘤(7.68％),而ACTH腺瘤及TSH腺瘤极少。只有FSH·LH腺瘤多发于男性,其他类型垂体腺瘤均多发于女性。PRL型、多激素型、GH型腺瘤多发于年轻者,而无激素型、FSH·LH型腺瘤多发于年龄大者。     

肢端肥大症型垂体腺瘤的临床及病理免疫分析

目的探讨肢端肥大症型垂体腺瘤病理免疫反应特点及与临床表现的关系。方法回顾性分析2008年1月至2013年6月采用单鼻孔直达蝶窦入路显微手术切除的84例肢大垂体腺瘤的临床资料,运用免疫化学发光法测定术前基础血内分泌激素水平,采用免疫组织化学的方法检测腺瘤内各种激素免疫反应阳性细胞。结果生长激素(GH)病理免疫反应平均光密度(AOD)值高于泌乳素(PRL)、促卵泡激素(FSH)、促肾上腺皮质激素(ACTH)、促黄体生成素(LH)(P0.05),GH与促甲状腺激素(TSH)比较差异无统计学意义(P0.05)。肿瘤内分泌激素免疫反应阳性表达数量依次为GH62例(74%)、PRL36例(43%)、TSH23例(27%);常见表达类型依次为GH 23例(27%)、GH+PRL 16例(19%)、PRL+TSH 8例(10%)。GH、PRL病理免疫阳性率、血液激素水平升高率及临床表现阳性率分别为74%、99%、100%及43%、15%、10%,差异有统计学意义(P0.05);TSH、ACTH、FSH、LH病理免疫阳性率分别为27%、18%、10%、8%,但临床内分泌激素测定均在正常范围内。结论GH、GH+PRL、PRL+TSH为肢大垂体瘤激素病理免疫反应常见类型,GH免疫表达与血内分泌激素水平及临床表现具有良好的相符性。肿瘤细胞分泌的TSH、PRL可能参与了肢大患者发病的病理生理过程。     

脑出血恢复期内分泌激素异常的研究

目的 探讨脑出血恢复期患者内分泌激素变化情况.方法 用放射免疫法测定90例脑出血患者发病后3个月,6个月,12个月周围静脉血中FT3、FT4、TSH、GH、ACTH、Cor、PRL、T、E2、FSH、LH、P的浓度.分析内分泌异常的发生率及其与出血量、有无并发症及恢复时间的关系.结果 内分泌激素异常在发病后3个月时发生率11.1％,6个月时发生率8.9％,12个月时发生率7.8％.随着恢复时间的延长逐渐下降,出血量越大分泌异常发生率越高,发病当时有并发症者恢复期内分泌激素异常发病率高.结论 脑出血恢复期内分泌异常有一定的发生率,有必要对恢复期患者进行常规的内分泌激素水平检查,并用于指导治疗.     

情感性精神障碍病人ACTH增高对睾酮的作用

目的本研究通过观察情感性精神障碍发作入院病人血清总睾酮（TES）,皮质醇（COR）,与血浆促肾上腺皮质激素（ACTH）升高的关系,探讨情感性精神障碍患者HPA轴的改变对性腺激素水平的作用。方法应用化学发光免疫分析法,检测急性发作入院的男性情感性精神障碍病人（80例）和精神分裂症患者（75例）血浆ACTH及血清TES、COR水平。结果情感性精神障碍病人和精神分裂症病人血浆ACTH水平均显著高于正常对照组（47士29）pg／mlvs（19±11）pg／ml（P〈0．01）,（54±33）pg／mlvs（19±11）pg／ml,P〈0．01,而血清TES和COR与对照组比较无统计学意义;以ACTH≥50pg／ml为增高组,以ACTH（50pg／ml为正常组分组,ACTH异常的情感性精神障碍病人血清TES浓度均显著高于ACTH正常的情感性精神障碍患者和对照组（623±233）mg／dlvs（412±274）mg／dl,P〈0．01,（623±233）mg／dlvs（469±171）mg／dl,（P〈0．01）,血清COR浓度亦高于ACTH正常的情感性障碍患者和对照组（19．8±5．]）μg／dlvs（16．2±6．5）μg／dl,P〈0．01,（19．8±5．1）pg／dlvs（17．4±5．2）μg／dl vs,P〈0．05）,ACTH的升高与TES、COR呈正相关（r=0．495,P〈0．01,r=0．345,P〈0．01）。结论情感性精神障碍病人ACTH增加,导致COR、TES的异常分泌,HPA轴的激活,可以引起性腺激素的分泌增加。进一步研究ACTH变化的内在规律,将对揭示情感障碍的发病机制有重要作用。     

Reboxetine acutely stimulates cortisol, ACTH, growth hormone and prolactin secretion in healthy male subjects

In this single-blind study the effects of acute oral administration of the selective noradrenaline reuptake inhibitor reboxetine on the cortisol (COR), ACTH, growth hormone (GH) and prolactin (PRL) secretion were examined in 12 healthy male volunteers. In a randomized order, the subjects received placebo or reboxetine (4 mg) at 0800 h on two different days. After insertion of an intravenous catheter, blood samples were drawn 1 hour prior to the administration of placebo or reboxetine, at time of administration, and during the time of 5 hours thereafter at periods of 30 minutes. Serum concentrations of COR, GH, and PRL as well as plasma levels of ACTH were determined in each blood sample by means of double antibody RIA, fluoroimmunoassay and chemiluminescence immunometric assay methods. The area under the curve (AUC) value was used as parameter for the COR, ACTH, GH, and PRL response. Using t-tests for paired samples, statistical analysis revealed significant stimulatory effects of reboxetine on COR, ACTH, GH, and PRL secretion, compared to placebo (mean AUC values+/-S.E.M. (a) reboxetine: COR 127893.20+/-8125.75 nmol/l x min; ACTH 2385.68+/-387.19 pmol/l x min; GH 56026.59+/-15594.87 pmol/l x min; PRL 113961.60+/-10280.44 pmol/l x min; (b) placebo: COR 83672.19+/-5225.20 nmol/l x min; ACTH 1449.83+/-190.67 pmol/l x min; GH 9308.16+/-3402.75 pmol/l x min; PRL 64663.28+/-7283.62 pmol/l x min). Mean arterial blood pressure and heart rate were significantly increased by reboxetine, too. Our results suggest that besides COR, ACTH and GH secretion, the release of PRL is also under the control of the noradrenergic systems in man.     

万拉法新对抑郁症患者血清性激素的影响

目的 探讨万拉法新对抑郁瘟患血清性激素的影响。方法 用放免法测定42例抑郁症患治疗前和治疗后1、6周末血清催乳素(PRL)、促滤泡成熟激素(FSH)、促黄体生成素(LH)、睾酮(T)、雌二醇(E2)，并与30例健康对照。结果 抑郁症组男性LH、E2和女性PRL、FSH与对照组比较明显升高。治疗后1、6周末男性患PRL、T、E2和女性PRL、T有显差异。结论 抑郁症患存在下丘脑—垂体—性腺轴内分泌异常，万拉法新可引起抑郁症患性激素分泌变异。     

Endocrinological effects of mirtazapine in healthy volunteers

Objective: Unlike other antidepressants, mirtazapine does not inhibit the reuptake of norepinephrine or serotonin (5-HT) but acts as an antagonist at presynaptic ₂-receptors and at postsynaptic 5-HT₂, 5-HT₃ and histamine H₁-receptors. In the present investigation, the influence of acute oral administration of 15-mg mirtazapine on the cortisol (COR), adrenocorticotropin (ACTH), growth hormone (GH) and prolactin (PRL) secretion was examined in 12 healthy male subjects, compared to placebo. Methods: After insertion of an intravenous catheter, both the mean arterial blood pressure (MAP) and the heart rate were recorded and blood samples were drawn 1 h prior to the administration of mirtazapine or placebo (7:00 a.m.), at time of administration (8:00 a.m.) and during 5 h thereafter in periods of 30 min. Concentrations of COR, ACTH, GH and PRL were measured in each blood sample by double antibody radioimmunoassay and chemiluminescence immunoassay methods. The area under the curve (AUC; 0–300 min after mirtazapine or placebo administration) was used as parameter for the COR, ACTH, GH and PRL response. Furthermore, the urinary free cortisol excretion (UFC) was determined beginning at 8:00 a.m. (time of administration of placebo or mirtazapine) up to 8:00 a.m. the day after. Results: Two-sided t-tests for paired samples revealed significantly lower COR AUC, ACTH AUC, UFC and PRL AUC values after 15-mg mirtazapine compared to placebo, whereas no significant differences were found with respect to GH AUC, MAP and heart rate. Conclusions: Since the acute inhibition of COR secretion in the healthy volunteers was paralleled by a simultaneous decrease of ACTH release, central mechanisms (e.g., inhibition of hypothalamic corticotropin releasing hormone (CRH) output) are suggested to be responsible for the inhibitory effects of mirtazapine on COR secretion. Our results are of particular interest in the light of the hypercortisolism observed in depressed patients and new pharmacological approaches such as CRH₁ receptor antagonists.     

Effect of the anticholinergic drug biperiden on pituitary hormones and cortisol

(1) Six healthy male volunteers received biperiden (10 mg), an anticholinergic drug, intravenously. (2) Blood samples showed significantly elevated levels of plasma cortisol and PRL during 180 min compared to a saline control day. (3) No change in GH, LH, FSH or TSH levels occurred after administration of biperiden. (4) Increased cortisol and PRL levels should be considered as possible neuroendocrine effects of anticholinergic agents as well as of neuroleptics and antidepressants with anticholinergic actions.     

Endocrinological effects of high-dose Hypericum perforatum extract WS 5570 in healthy subjects

In this single-blind study, the effects of acute oral administration of high-dose Hypericum perforatum extract WS 5570 on the cortisol (COR), adrenocorticotropic hormone (ACTH), growth hormone (GH), and prolactin (PRL) secretions were examined in 12 healthy male volunteers. In a randomized order, the subjects received placebo or WS 5570 at several dosages (600, 900, and 1,200 mg) at 08.00 h on 4 different days. After insertion of an intravenous catheter, blood samples were drawn 1 h prior to administration of placebo or WS 5570 (600, 900, or 1,200 mg), at the time of administration, and during 5 h thereafter at intervals of 30 min. The serum concentrations of COR, GH, and PRL as well as the plasma levels of ACTH were determined in each blood sample by means of double antibody radioimmunoassay, fluoroimmunoassay, and chemiluminescence immunometric assay methods. The area under the curve value was used as parameter for COR, ACTH, GH, and PRL responses. Repeated-measures Anova revealed a significant stimulatory effect of WS 5570 on the ACTH secretion, whereas COR and PRL secretions were not significantly influenced. Moreover, there was a stimulatory peak of GH release 240 min after challenge with WS 5570 in some but not all volunteers, without reaching statistical significance in comparison with placebo. Mean arterial blood pressure and heart rate remained unchanged after administration of WS 5570. Apparently, WS 5570 at the dosages given in this study inconsistently causes endocrinological effects in healthy subjects by influencing central neurotransmitters.     

脑损伤恢复期神经内分泌改变及临床意义

目的探讨脑损伤恢复期神经内分泌激素异常的发生率及其临床意义。方法用放射免疫法测定患者脑损伤后3,6,12月周围静脉血中FT3、FT4、TSH、ACTH、GH、Cor、PRL、T、E2、P、FSH、LH的浓度,统计分析脑损伤恢复期神经内分泌激素异常的发生率及其与病情严重程度及恢复时间的关系。结果激素异常发生率和损伤严重程度呈正相关,损伤越重,激素异常发生率越高,差异有统计学意义(P0.05)。激素异常发生率随着时间的推移逐渐降低,3个月时为17.6%,6个月为16.2%,12个月为15.4%。但差异无统计学意义(P0.05)。结论颅脑损伤恢复期神经内分泌激素水平异常有一定的发生率,损伤越重,激素异常率越高,随着恢复时间的延长有下降趋势,可作为恢复期一项重要的检测指标,用于指导临床治疗。     

抑郁症患者的性激素分析

目的　研究抑郁症患者垂体促性腺激素及外周性激素的功能状态,探讨性激素水平改变与性有关症状和药物治疗的关系。方法　采用放射免疫法测定３０ 例（ 男１１ 例,女１９ 例） 抑郁症患者血清促卵泡激素（ Ｆ Ｓ Ｈ） 、黄体生成素（ Ｌ Ｈ） 、催乳素（ Ｐ Ｒ Ｌ） 、睾丸酮（ Ｔ） 、雌二醇（ Ｅ２） 等激素水平,并与２０ 例（ 男女各１０ 例） 正常人对照。结果　试验组男性 Ｌ Ｈ 和女性 Ｆ Ｓ Ｈ、 Ｒ Ｐ Ｌ 明显高于对照组,其他性激素水平两组间无显著性差异。药物治疗前后男性患者 Ｐ Ｒ Ｌ、 Ｔ、 Ｅ２ ,女患者 Ｐ Ｒ Ｌ、 Ｔ 等激素分泌改变非常显著。结论　提示抑郁症患者性腺轴存在功能失调。性有关症状与性激素水平改变无关。抗抑郁治疗可导致性激素分泌紊乱。     

Changes in anterior pituitary function during ACTH therapy of patients with infantile spasms

Serum cortisol, prolactin (PRL), TSH, GH, LH and FSH levels were measured before and immediately after daily ACTH-Z therapy (0.01 mg/kg/day, 1-2 weeks) for 5 patients with infantile spasms and one patient with myoclonus epilepsy. Total number of ACTH-Z therapy were 8 times, and all patients became seizure free after ACTH-Z therapy. In 6 occasions, TRH, LH-RH and insulin tolerance tests were performed before and after daily ACTH-Z therapy. Serum cortisol levels were significantly increased after daily ACTH-Z therapy but all other hormone levels were significantly decreased. In TRH and LH-RH tolerance tests, peak levels and increments of PRL, LH and FSH were significantly decreased after daily ACTH-Z therapy and those of TSH were mildly decreased. In one case insulin tolerance test revealed an adequate decrease of blood glucose before and after ACTH-Z therapy, and there was a poor GH response after ACTH-Z therapy. Daily ACTH-Z therapy was thought to suppress secretion of anterior pituitary hormones.     

d-Lys-GHRP-6 does not modify the endocrine response to acylated ghrelin or hexarelin in humans

Acylated ghrelin exerts numerous endocrine and non-endocrine activities via the GH Secretagogue receptor type 1a (GHS-R1a). D-Lys-GHRP-6 has been widely studied in vitro and in vivo in animal studies as GHS-R1a antagonist; its action in humans has, however, never been tested so far. Aim of our study was to verify the antagonistic action of D-Lys-GHRP-6 on the endocrine responses to acylated ghrelin and hexarelin, a peptidyl synthetic GHS, in humans. The effects of different doses of D-Lys-GHRP-6 (2.0microg/kg iv as bolus or 2.0microg/kg/h iv as infusion) on both spontaneous and acylated ghrelin- or hexarelin (1.0microg/kg iv as bolus) -stimulated GH, PRL, ACTH and cortisol levels were studied in six normal volunteers (age [mean+/-SEM]: 25.4+/-1.2yr; BMI: 22.3+/-1.0kg/m(2)). The effects of D-Lys-GHRP-6 (2.0microg/kg iv as bolus+4.0microg/kg/h iv) on the GH response to 0.25microg/kg iv as bolus acylated ghrelin was also studied. During saline, spontaneous ACTH and cortisol decrease was observed while non changes occurred in GH and PRL levels. Acylated ghrelin and hexarelin stimulated (p<0.05) GH, PRL, ACTH and cortisol secretions. D-Lys-GHRP-6 administered either as bolus or a continuous infusion did not modify both spontaneous and acylated ghrelin- or hexarelin-stimulated GH, PRL, ACTH and cortisol secretion. D-Lys-GHRP-6 did not modify even the GH response to 0.25microg/kg iv acylated ghrelin. In conclusion, D-Lys-GHRP-6 does not affect the neuroendocrine response to both ghrelin and hexarelin. These findings question D-Lys-GHRP-6 as an effective GHS-R1a antagonist for human studies.