柯兴病患者N—POMC分泌对糖皮质激素负反馈调节的反应变迟钝

本文研究了静脉注射氢化考的松(135mg)对柯兴病患者血N-POMC水平的影响,并和阿狄森病及先天性肾上腺皮质增生症进行比较。结果证明,柯兴病患者(包括未治组、肾上腺次全切组及纳尔逊综合征组)静注氢考后血N-POMC的抑制率明显低于阿狄森病组及先天性肾上腺皮质增生症组(P<0.001),而柯兴病三组间无明显差别。以上结果说明,在柯兴病患者,AGTH/N-POMC分泌对糖皮质激素负反馈调节的反应是迟钝的,这种迟钝反应与血皮质醇水平的高低无直接关系,却反映了柯兴病患者垂体ACTH分泌的相对自主性。

THE NEGATIVE FEEDBACK REGULATION OF PITUITARY N-POMC SECRETION BY GLUCO CORTICOIDS WAS BLUNTED IN CUSHING''S DISEASE

The effect of hydrocortisone (135 nag i.v. as a bolus) on the levels of serum N-POMC was studied in the patients with Cushing's disease [including three groups: untreated (CD, n=8), post-adrenolectomy without Nelson's syndrome (CDA, n=5), and Nelson's syndrome (NS, n=4)]; Addison's disease (AD, n = 13) and congenital adrenal hyperplasia (CAH, n=4). The results showed that the levels of serum N-POMC were decreased after the administration of hydrocortisone in all three groups of Cushing's disease, however the suppression rate of N-POMC was much lower in these groups than that in AD and CAH (P<0.001). There were no difference of the supression rate between the groups of Cushing's disease, though the basal levels of plasma cortisol or serum N-POMC were significantly different in these three groups. The suppression rate of N-POMC in AD was lower than that in CAH. It was concluded that negative feedback iegula-tion of ACTH / N-POMC secretion by glucocorticoids was blunted in Cushing's disease and it was not related to the hypercortisoiism, and may be caused by pituitary ACTH adenoma which is autonomous. The glucocorticoid feedback regulation was slightly blunted in Addison's disease.