Adrenocorticotrophin (ACTH) deficiency undetected by standard dynamic tests of the hypothalamic-pituitary-adrenal axis
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Ημερομηνία
Τίτλος Εφημερίδας
Περιοδικό ISSN
Τίτλος τόμου
Εκδότης
Περίληψη
Τύπος
Είδος δημοσίευσης σε συνέδριο
Είδος περιοδικού
peer-reviewed
Είδος εκπαιδευτικού υλικού
Όνομα συνεδρίου
Όνομα περιοδικού
Clin Endocrinol (Oxf)
Όνομα βιβλίου
Σειρά βιβλίου
Έκδοση βιβλίου
Συμπληρωματικός/δευτερεύων τίτλος
Περιγραφή
Six patients (four females, two males; aged 18-65 years), previously treated by external pituitary irradiation (2000-4000 cGY in 8-15 fractions over 10-20 days) for pituitary tumours, presented with the symptoms of excessive and inappropriate tiredness suggestive of ACTH deficiency, despite a normal peak cortisol response to an insulin tolerance test (four cases) or to a glucagon stimulation test (two cases). These six patients were found to have significantly lower mean 24 h urinary free cortisol levels (100 +/- 40 nmol; mean +/- SD) compared with the mean value of 31 normal controls (210 +/- 70.8 nmol; P less than 0.01). In addition serum cortisol profiles based on a series of four timed samples between 0900-2300 h were subnormal (mean 130 nmol/l) in comparison with profiles obtained from 12 normal controls (mean 270 nmol/l) (P less than 0.001). Glucocorticoid replacement therapy promptly abolished their symptoms. These results suggest that a discordance between ACTH secretion under basal circumstances and ACTH response to pharmacological tests may exist in patients with ACTH deficiency. We speculate that defective endogenous corticotrophin-releasing hormone (CRF) secretion, due to radiation-induced damage at hypothalamic level, is one cause of this phenomenon.
Περιγραφή
Λέξεις-κλειδιά
Adolescent, Adrenocorticotropic Hormone/*deficiency, Adult, Aged, Female, Glucagon/diagnostic use, Humans, Hypothalamo-Hypophyseal System/*physiopathology/radiation effects, Insulin/diagnostic use, Male, Middle Aged, Pituitary Neoplasms/blood/radiotherapy, Pituitary-Adrenal System/*physiopathology/radiation effects, Radiation Injuries/blood/physiopathology
Θεματική κατηγορία
Παραπομπή
Σύνδεσμος
http://www.ncbi.nlm.nih.gov/pubmed/2844448
http://onlinelibrary.wiley.com/store/10.1111/j.1365-2265.1988.tb03659.x/asset/j.1365-2265.1988.tb03659.x.pdf?v=1&t=h0outa5a&s=4cfa75ce917e2b7712b446ec80ce4fd122acb0bf
http://onlinelibrary.wiley.com/store/10.1111/j.1365-2265.1988.tb03659.x/asset/j.1365-2265.1988.tb03659.x.pdf?v=1&t=h0outa5a&s=4cfa75ce917e2b7712b446ec80ce4fd122acb0bf
Γλώσσα
en
Εκδίδον τμήμα/τομέας
Όνομα επιβλέποντος
Εξεταστική επιτροπή
Γενική Περιγραφή / Σχόλια
Ίδρυμα και Σχολή/Τμήμα του υποβάλλοντος
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής