Shimizu H, Nihei S, Yoshihama Y, Okamura S, Sato N, Shimomura Y, Mori M
First Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan.
J Med. 1992;23(2):141-8.
We report on a patient with isolated ACTH deficiency accompanying deficient insulin response to glucose. The subject is a 59 year-old male. He was admitted to our hospital because of a hypoglycemic attack. Urinary excretion of 17-hydroxycorticosteroid (17-OHCS) and 17-ketosteroid (17-KS) was low. Plasma ACTH levels decreased and serum cortisol levels were undetectable. ACTH did not respond to CRF stimulation for three consecutive days. Antibodies to At-T 20 cells (anterior pituitary cell-derived cell line) were positive in the serum of this patient. Serum immunoreactive insulin (IRI) levels were not detected throughout the day. The urinary excretion of C-peptide decreased to 9.8 micrograms/day. IRI responses on 75 g oral glucose tolerance test (OGTT) were examined at one and two months after the start of cortisol supplementation. No remarkable IRI response was observed, although blood glucose levels were maintained within the normal range. Eight months after the start of cortisol supplementation, the insulin response to 75 g OGTT appeared. The present study suggests that the recovery from hypo-insulinemia may be delayed even after normalization of serum cortisol levels in ACTH deficiency. This may be possibly due to the salutary effects of cortisol in maintaining plasma insulin levels. The time lag may be due to other factors also.
我们报告了一例孤立性促肾上腺皮质激素（ACTH）缺乏伴对葡萄糖胰岛素反应不足的患者。该患者为一名59岁男性。他因低血糖发作入院。尿17-羟皮质类固醇（17-OHCS）和17-酮类固醇（17-KS）排泄量低。血浆ACTH水平降低，血清皮质醇水平检测不到。连续三天，ACTH对促肾上腺皮质激素释放因子（CRF）刺激无反应。该患者血清中抗At-T 20细胞（垂体前叶细胞衍生细胞系）抗体呈阳性。全天均未检测到血清免疫反应性胰岛素（IRI）水平。C肽尿排泄量降至9.8微克/天。在开始补充皮质醇后1个月和2个月时，对75克口服葡萄糖耐量试验（OGTT）的IRI反应进行了检测。尽管血糖水平维持在正常范围内，但未观察到明显的IRI反应。开始补充皮质醇8个月后，对75克OGTT出现了胰岛素反应。本研究表明，在ACTH缺乏症中，即使血清皮质醇水平恢复正常，低胰岛素血症的恢复可能也会延迟。这可能是由于皮质醇对维持血浆胰岛素水平有有益作用。这种时间延迟也可能是由于其他因素。
