Demelia L, Solinas A, Poma R, Vallebona E, Pitzus F
Istituto di Clinica Medica, Università degli Studi di Cagliari.
Ann Ital Med Int. 1991 Apr-Jun;6(2):203-9.
With the aim of evaluating the glucocorticoid function and the role of the adrenal gland in hypogonadism and feminization of cirrhotic patients, we examined 11 patients with virus-induced liver cirrhosis and 8 normal subjects as controls. In each subject serum levels of cortisol (C), progesterone (P), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEAS), delta 4-androstenedione (A), estrone (E1), testosterone (T), luteinizing hormone (LH) were assayed in basal conditions and after adrenocorticotropic hormone (ACTH) stimulation. Serum levels of ACTH, C, E1, estradiol (E2), T were assayed in basal condition and after dexamethasone suppression test. Moreover, a circadian study of ACTH, C and corticosteroid-binding globulin (CBG) was performed, with blood samples drawn at 8:00 and 20:00 on two consecutive days. Our results demonstrate that in cirrhosis: 1) normal levels of C, when metabolism is altered and CBG levels are reduced, are maintained by inhibition of ACTH secretion; 2) circadian rhythmicity of the pituitary-adrenal axis is well preserved; 3) in non-alcoholic cirrhosis, too, there is a reduction of androgens (T, DHEA, DHEAS, A) and a rise of estrogens (E2 and, more markedly, E1) and P; 4) in cirrhotic men E1 is mainly of adrenal origin and contributes, through negative feedback on LH secretion, to low levels of T.
为了评估糖皮质激素功能以及肾上腺在肝硬化患者性腺功能减退和女性化过程中的作用，我们检查了11例病毒诱导的肝硬化患者，并以8名正常受试者作为对照。对每位受试者在基础状态下以及促肾上腺皮质激素（ACTH）刺激后测定血清皮质醇（C）、孕酮（P）、脱氢表雄酮（DHEA）、硫酸脱氢表雄酮（DHEAS）、Δ4-雄烯二酮（A）、雌酮（E1）、睾酮（T）、黄体生成素（LH）的水平。在基础状态下以及地塞米松抑制试验后测定血清ACTH、C、E1、雌二醇（E2）、T的水平。此外，进行了ACTH、C和皮质类固醇结合球蛋白（CBG）的昼夜研究，连续两天在8:00和20:00采集血样。我们的结果表明，在肝硬化患者中：1）当代谢改变且CBG水平降低时，通过抑制ACTH分泌维持C的正常水平；2）垂体-肾上腺轴的昼夜节律性保存良好；3）在非酒精性肝硬化中，雄激素（T、DHEA、DHEAS、A）也减少，雌激素（E2，更明显的是E1）和P升高；4）在肝硬化男性中，E1主要来源于肾上腺，并通过对LH分泌的负反馈作用导致T水平降低。
