低剂量（1微克）与标准剂量（250微克）促肾上腺皮质激素刺激试验对多囊卵巢综合征女性肾上腺P450c17α酶活性影响的比较

A comparison between the effects of low dose (1 microg) and standard dose (250 microg) ACTH stimulation tests on adrenal P450c17alpha enzyme activity in women with polycystic ovary syndrome.

作者信息

Colak Ramiz, Keleştimur Fahrettin, Unlühizarci Kürşad, Bayram Fahri, Sahin Yilmaz, Tutuş Ahmet

机构信息

Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.

出版信息

Eur J Endocrinol. 2002 Oct;147(4):473-7. doi: 10.1530/eje.0.1470473.

DOI:10.1530/eje.0.1470473

PMID:12370108

Abstract

OBJECTIVE

Numerous studies have found elevated androgen production by the adrenal glands in patients with polycystic ovary syndrome (PCOS). However, the role and the mechanisms responsible for the adrenal androgen excess in women with PCOS are not well understood.

DESIGN

Our aim was to compare 17-hydroxyprogesterone (17-OHP), androstenedione, dehydroepiandrosterone sulfate (DHEAS) and cortisol responses to a low dose (1 microg) ACTH stimulation test (LDT) with the responses to a standard dose (250 microg) ACTH stimulation test (SDT) in patients with PCOS.

METHODS

Fifty women with PCOS (mean age 25.4+/-0.7 years) and 20 healthy women (mean age 27.3+/-2.2 years) were included in the study. The patients and controls underwent ACTH stimulation tests with 1 microg and 250 microg synthetic ACTH in the follicular phase of their cycles. Venous blood was drawn at 0, 30 and 60 min for determination of serum cortisol, 17-OHP, androstenedione and DHEAS levels.

RESULTS

In PCOS subjects, peak and area under the curve (AUC) 17-OHP (9.3+/-0.3 nmol/l, 378.4+/-61 nmol/lx60 min), androstenedione (15.6+/-0.6 nmol/l, 806.4+/-52 nmol/lx60 min) and DHEAS (7.5+/-0.4 micromol/l, 385.6+/-25.5 micromol/lx60 min) responses to SDT were significantly higher than the levels in healthy women (respectively 5.7+/-0.3 nmol/l and 249.4+/-52.2 nmol/lx60 min for 17-OHP; 9.1+/-0.3 nmol/l and 413.7+/-31.6 nmol/lx60 min for androstenedione; 4.3+/-0.4 micromol/l and 224.9+/-24.5 micromol/lx60 min for DHEAS) (P<0.05). Peak and AUC cortisol responses to SDT were similar in PCOS and control subjects. Peak and AUC cortisol and 17-OHP responses to LDT in women with PCOS were similar to the values obtained in healthy women. Peak androstenedione (12.5+/-0.6 nmol/l) and peak (6.5+/-0.5 nmol/l) and AUC (336.3+/-22.4 micromol/lx60 min) DHEAS responses to LDT were significantly higher in women with PCOS.

CONCLUSIONS

These results show that LDT is capable of revealing the adrenal hyperactivity in women with PCOS. Adrenal P450c17alpha enzyme dysregulation in PCOS is revealed by ACTH stimulation at a pharmacological dose (250 microg) but not by a physiological dose (1 microg). LDT is able to demonstrate adrenal hyperactivity characterized by an increase in DHEAS levels.

摘要

目的

大量研究发现多囊卵巢综合征（PCOS）患者肾上腺雄激素分泌增加。然而，PCOS 女性肾上腺雄激素过多的作用及机制尚未完全明确。

设计

我们的目的是比较 PCOS 患者对低剂量（1μg）促肾上腺皮质激素（ACTH）刺激试验（LDT）和标准剂量（250μg）ACTH 刺激试验（SDT）时 17-羟孕酮（17-OHP）、雄烯二酮、硫酸脱氢表雄酮（DHEAS）和皮质醇的反应。

方法

50 例 PCOS 女性（平均年龄 25.4±0.7 岁）和 20 例健康女性（平均年龄 27.3±2.2 岁）纳入本研究。患者和对照组在月经周期的卵泡期接受 1μg 和 250μg 合成 ACTH 的刺激试验。在 0、30 和 60 分钟时采集静脉血，测定血清皮质醇、17-OHP、雄烯二酮和 DHEAS 水平。

结果

在 PCOS 患者中，SDT 时 17-OHP（9.3±0.3nmol/L，378.4±61nmol/L×60 分钟）、雄烯二酮（15.6±0.6nmol/L，806.4±52nmol/L×60 分钟）和 DHEAS（7.5±0.4μmol/L，385.6±25.5μmol/L×60 分钟）的峰值和曲线下面积（AUC）反应显著高于健康女性（17-OHP 分别为 5.7±0.3nmol/L 和 249.4±52.2nmol/L×60 分钟；雄烯二酮为 9.1±0.3nmol/L 和 413.7±31.6nmol/L×60 分钟；DHEAS 为 4.3±0.4μmol/L 和 224.9±24.5μmol/L×60 分钟）（P<0.05）。PCOS 患者和对照组 SDT 时皮质醇的峰值和 AUC 反应相似。PCOS 女性对 LDT 的皮质醇和 17-OHP 峰值及 AUC 反应与健康女性相似。PCOS 女性对 LDT 的雄烯二酮峰值（12.5±0.6nmol/L）、DHEAS 峰值（6.5±0.5nmol/L）和 AUC（336.3±22.4μmol/L×60 分钟）反应显著更高。