Winkler Andrea Sylvia, Landau Sabine, Chaudhuri K Ray
Consultant Neurologist, King's College Hospital, Mapother House, Denmark Hill, London SE5 9RS, UK. ray.chaudhuri @ kingshc.nhs
Clin Auton Res. 2002 Oct;12(5):393-8. doi: 10.1007/s10286-002-0025-y.
The hypothalamic-pituitary axis (HPA) may be involved early in multiple system atrophy (MSA), whereas in idiopathic Parkinson's disease (IPD) its impairment seems to be correlated with motor disability. The release of prolactin (PRL) is mediated through the HPA and an increase in PRL levels is documented during stress. In this study, we investigated basal and erect PRL levels to assess whether basal PRL or changes in PRL levels after 60 degrees head-up tilt (HUT; orthostatic stress) could distinguish between MSA and IPD patients. We studied five patients with MSA on levodopa treatment, five levodopa-naive MSA patients, nine IPD patients on dopaminergic treatment, six drug-naive IPD patients and six normal individuals. PRL levels were measured in the supine position after 30 minutes rest and during 60 degrees HUT after 5 and 15 minutes. Baseline PRL values were significantly lower for patients with IPD than for those with MSA, both for levodopa-treated and naive patients ( p < 0.004, estimated decrease 55.1 %, 95 % CI from 29.4 % to 71.52 %). After orthostatic stress PRL levels were increased in healthy individuals after 15 minutes of HUT ( p = 0.044, estimated increase 11.5 %, 95 % CI from 0.4 % to 23.8 %), whereas there was no evidence for a change of PRL levels in patients with MSA or IPD after 5 and 15 minutes of HUT. We also did not find any evidence for a difference in PRL change after HUT between MSA and IPD patients. Baseline PRL levels might differentiate between early MSA and IPD, being higher in MSA. However, orthostatic stress using HUT appears unable to differentiate between MSA and IPD.
下丘脑 - 垂体轴（HPA）可能在多系统萎缩（MSA）早期就受累，而在特发性帕金森病（IPD）中，其功能损害似乎与运动功能障碍相关。催乳素（PRL）的释放通过HPA介导，应激期间PRL水平会升高。在本研究中，我们调查了基础PRL水平和直立位PRL水平，以评估基础PRL或60度头高位倾斜（HUT；直立应激）后PRL水平的变化是否能区分MSA患者和IPD患者。我们研究了5例接受左旋多巴治疗的MSA患者、5例未接受左旋多巴治疗的MSA患者、9例接受多巴胺能治疗的IPD患者、6例未接受药物治疗的IPD患者和6名正常个体。在休息30分钟后的仰卧位以及HUT 5分钟和15分钟后的60度倾斜位测量PRL水平。无论是接受左旋多巴治疗的患者还是未接受治疗的患者，IPD患者的基线PRL值均显著低于MSA患者（p < 0.004，估计下降55.1%，95%置信区间为29.4%至71.52%）。直立应激后，健康个体在HUT 15分钟后PRL水平升高（p = 0.044，估计升高11.5%，95%置信区间为0.4%至23.8%），而MSA或IPD患者在HUT 5分钟和15分钟后没有PRL水平变化的证据。我们也没有发现MSA和IPD患者在HUT后PRL变化存在差异的证据。基线PRL水平可能有助于区分早期MSA和IPD，MSA患者的基线PRL水平更高。然而，使用HUT的直立应激似乎无法区分MSA和IPD。
