Oki Kenji, Yamane Kiminori, Yoneda Masayasu, Nojima Hideki, Watanabe Hiroshi, Kohno Nobuoki
Department of Molecular and Internal Medicine, Graduate School Biomedical Sciences, Hiroshima University, Japan.
Endocr J. 2007 Dec;54(5):765-9. doi: 10.1507/endocrj.k06-216. Epub 2007 Sep 18.
An eighty-year-old man who had complained of skin pigmentation and weight loss was referred to our hospital. Upon physical examination, marked hyperpigmentation was found on the whole body including oral mucosa, tongue and fingernails. Endocrinological findings showed increased ACTH (126 pg/ml) and normal serum cortisol (15.4 microg/dl). First, we used a 250 microg cosyntropin stimulation test which is valid to diagnose Addison's disease, resulting in an adequate cortisol response. Second, we performed 1 microg cosyntropin stimulation test, and the cortisol response was blunted. Since the diagnosis of Addison's disease was fairly certain, he was treated with hydrocortisone 15 mg/day, and improvement of his skin pigmentation and an increase in body weight were observed. To our knowledge, this is the first report that 1 mug cosyntropin stimulation test was helpful to make diagnosis as having Addison's disease rather than the 250 microg cosyntropin stimulation test, although it is established that the 1 mug cosyntropin stimulation test is useful in secondary or relative adrenal insufficiency.
一位曾抱怨皮肤色素沉着和体重减轻的80岁男性被转诊至我院。体格检查时，发现其全身包括口腔黏膜、舌头和指甲均有明显的色素沉着。内分泌检查结果显示促肾上腺皮质激素（ACTH）升高（126 pg/ml），血清皮质醇正常（15.4 μg/dl）。首先，我们进行了250 μg促肾上腺皮质激素释放激素刺激试验，该试验对诊断艾迪生病有效，结果显示皮质醇反应正常。其次，我们进行了1 μg促肾上腺皮质激素释放激素刺激试验，皮质醇反应减弱。由于艾迪生病的诊断相当明确，遂给予他每天15 mg氢化可的松治疗，观察到其皮肤色素沉着有所改善，体重增加。据我们所知，这是第一份报告指出，1 μg促肾上腺皮质激素释放激素刺激试验有助于诊断艾迪生病，而非250 μg促肾上腺皮质激素释放激素刺激试验，尽管公认1 μg促肾上腺皮质激素释放激素刺激试验对继发性或相对性肾上腺皮质功能不全有用。
