Adrenocorticotrophin (ACTH) deficiency undetected by standard dynamic tests of the hypothalamic-pituitary-adrenal axis
Φόρτωση...
Ημερομηνία
Συγγραφείς
Tsatsoulis, A.
Shalet, S. M.
Harrison, J.
Ratcliffe, W. A.
Beardwell, C. G.
Robinson, E. L.
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