Borkowski A, L'hermite M, Dor P, Longeval E, Rozencweig M, Muquardt C, Van Cauter E
J Endocrinol. 1977 May;73(2):235-46. doi: 10.1677/joe.0.0730235.
The endocrine response to prolonged dexamethasone treatment was investigated in six postmenopausal women with generalized mammary carcinoma. Plasma cortisol levels decreased rapidly and became undetectable whereas significant concentrations of plasma dehydroepiandrosterone and androstenedione persisted throughout the study, even in two ovariectomized patients, indicating a certain degree of autonomy or a greater resistance of adrenal 'androgens' to the inhibition of ACTH secretion. Except in the ovariectomized patients, plasma testosterone did not fall significantly whereas the plasma oestrogens tended progressively towards undetectable concentrations. A similar response was found in six normal postmenopausal women although the disappearance of their oestrogens was relatively rapid. This indicates that much of the testosterone present after the menopause could still be produced by the ovaries whereas the ovarian production of oestrogens becomes negligible. The delayed disappearance of oestrogens in the patients with mammary carcinoma indicates that the persisting adrenal 'androgens' remained efficient precursors of oestrogen synthesis within the peripheral tissues and presumably within the mammary tumour itself. Plasma dihydrotestosterone behaved like the plasma oestrogens. Despite the fall in plasma oestrogens, plasma gonadotrophins did not increase further but plasma prolactin rose progressively. The persistance of steroid sex hormones and the rise of plasma prolactin might explain the poor response to dexamethasone treatment in mammary carcinoma.
对6例患有广泛性乳腺癌的绝经后女性进行了长期地塞米松治疗的内分泌反应研究。血浆皮质醇水平迅速下降并变得无法检测到，而血浆脱氢表雄酮和雄烯二酮的显著浓度在整个研究过程中持续存在，即使在两名卵巢切除的患者中也是如此，这表明肾上腺“雄激素”具有一定程度的自主性或对促肾上腺皮质激素分泌抑制的更大抵抗力。除卵巢切除的患者外，血浆睾酮没有显著下降，而血浆雌激素则逐渐趋向于无法检测到的浓度。在6名正常绝经后女性中也发现了类似的反应，尽管她们的雌激素消失相对较快。这表明绝经后存在的大部分睾酮仍可由卵巢产生，而卵巢雌激素的产生则变得微不足道。乳腺癌患者中雌激素的延迟消失表明，持续存在的肾上腺“雄激素”在外周组织内，大概也在乳腺肿瘤本身内，仍然是雌激素合成的有效前体。血浆双氢睾酮的表现与血浆雌激素相似。尽管血浆雌激素下降，但血浆促性腺激素没有进一步增加，而血浆催乳素则逐渐上升。甾体性激素的持续存在和血浆催乳素的升高可能解释了乳腺癌对地塞米松治疗反应不佳的原因。
