Kimura T, Ota K, Shoji M, Inoue M, Sato K, Ohta M, Yamamoto T, Shimizu Y, Yoshinaga K
Second Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Acta Endocrinol (Copenh). 1992 Mar;126(3):217-23. doi: 10.1530/acta.0.1260217.
To assess whether arginine vasopressin and atrial natriuretic hormone participate in impaired urinary dilution and excretion in glucocorticoid deficiency secondary to hypopituitarism, an acute oral water load of 20 ml.kg-1 BW was undertaken in the absence and presence of an oral hydrocortisone (60 mg) treatment in patients with ACTH deficiency (N = 7) and panhypopituitarism (N = 2). Plasma arginine vasopressin and atrial natriuretic hormone and renal water handling were simultaneously determined and compared with those in similarly water-loaded normal subjects. Plasma arginine vasopressin did not fall in response to decreased blood osmolality after an acute water load in the absence of hydrocortisone; plasma atrial natriuretic hormone did not change despite blood volume expansion; and impairment in urinary dilution and excretion remained. On the other hand, in the presence of hydrocortisone, plasma arginine vasopressin fell in response to a decrease in plasma osmolality and plasma atrial natriuretic hormone increased, thereby restoring urinary dilution and excretion. These results demonstrate that the impaired arginine vasopressin response to acute water loading play an essential role in deranged renal water and electrolyte handling in the state of glucocorticoid deficiency; the impaired release of atrial natriuretic hormone also may affect these disorders.
为评估精氨酸血管加压素和心钠素是否参与继发于垂体功能减退的糖皮质激素缺乏状态下的尿液稀释和排泄受损，对7例促肾上腺皮质激素（ACTH）缺乏患者和2例全垂体功能减退患者，在口服氢化可的松（60mg）治疗前后分别给予20ml·kg-1体重的急性口服水负荷。同时测定血浆精氨酸血管加压素、心钠素及肾脏对水的处理情况，并与同样进行水负荷的正常受试者进行比较。在无氢化可的松时，急性水负荷后血浆精氨酸血管加压素未因血渗透压降低而下降；尽管血容量增加，血浆心钠素也未改变；尿液稀释和排泄仍受损。另一方面，在有氢化可的松时，血浆精氨酸血管加压素随血浆渗透压降低而下降，血浆心钠素增加，从而恢复尿液稀释和排泄。这些结果表明，精氨酸血管加压素对急性水负荷反应受损在糖皮质激素缺乏状态下肾脏水和电解质处理紊乱中起重要作用；心钠素释放受损也可能影响这些紊乱。
