136例库欣综合征病人垂体肾上腺皮质激素分泌特征分析  

THE CHARACTERISTICS OF PLASMA ACTH, SERUM CORTISOL AND UFC IN 136 PATIENTS WITH CUSHING SYNDROME

作　　者：汪寅章[1] 闫双通[1] 宗文漪[1] 

机构地区：[1]解放军总医院

出　　处：《解放军医学杂志》2003年第6期537-539,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：为评估库欣综合征病人血浆ACTH(pACTH)、血清皮质醇 (SC)、尿游离皮质醇 (UFC)、小剂量和大剂量地塞米松抑制试验的诊断价值 ,回顾性分析了 1 36例已确诊为库欣病、肾上腺皮质肿瘤或不依赖ACTH性肾上腺皮质结节性增生症 (AINAH)等患者的pACTH、SC、UFC水平及地塞米松抑制试验的特点。结果显示 ,绝大多数库欣综合征患者SC和UFC(尤其SC 0 :0 0和UFC)水平升高 ;pACTH水平可明确区分库欣病和肾上腺皮质肿瘤或AINAH ;pACTH水平对库欣病诊断价值高于CT/MRI检查 ;激素昼夜分泌节律紊乱及不被小剂量地塞米松抑制是所有库欣综合征的共同特征 ,而肾上腺皮质肿瘤或AINAH则不受大剂量地塞米松抑制。结果表明 ,SC和UFC水平升高、激素分泌节律丧失及不受小剂量地塞米松抑制是诊断库欣综合征的最重要依据 。To evaluate the significance of plasma ACTH (pACTH), serum cortisol (SC) and urinary free cortisol UFC as well as low or high dose dexamethasone suppression test in Cushing syndrome, the levels of hormones were evaluated in 136 cases of Cushing syndrome. It was found that the levels of SC and UFC were elevated in almost all the 121 patients with Cushing syndrome. The mean levels of pACTH were higher in 86 patients with Cushing disease and lower in 36 cases with adrenocortical tumor or ACTH independent nodular adrenocortical hyperplasia (AINAH) than those in normal subjects. The ACTH levels might be in normal range in many patients with Cushing syndrome, but they were higher in patients with Cushing disease and lower in the patients with adrenocortical tumor or AINAH than those of the high limit at ACTH0am in normal subjects. It was a common feature that the diurnal rhythm of hormone secretion disappeared and the hormone levels were not suppressed by low dose dexamethasone suppression test in the patients with Cushing syndrome. In more than 90% of the patients with adrenocortical tumor or AINAH the levels of SC and UFC were not suppressed by high dose dexamethasone. In 12 of clinically cured patients with Cushing disease the levels of pACTH8am, SC8am and UFC were normal or even low. The pACTH levels were low in two patients with iatrogenic Cushing syndrome. The results suggested that examinations of SC, UFC and low dose dexamethasone suppression test were very important in the diagnosis of Cushing syndrome. The pACTH level was a key parameter to distinguish Cushing disease from adrenocortical tumor or AINAH.

关 键 词：库欣综合征 促肾上腺皮质激素 皮质醇 尿游离皮质醇 

分 类 号：R586.04[医药卫生—内分泌]