Grunwald K, Rabe T, Urbancsek J, Runnebaum B, Vecsei P
Department of Obstetrics and Gynecology, University of Heidelberg, Germany.
Gynecol Endocrinol. 1990 Dec;4(4):287-306. doi: 10.3109/09513599009024983.
Normal values in endocrine testing are the most important precondition for the recognition of disorders of the endocrine system. To establish a reference range for adrenocorticotropic hormone (ACTH) stimulation tests, an intravenous and intramuscular ACTH stimulation test was conducted in 29 female volunteers without hyperandrogenism. A total of 25 IU of ACTH were administered intravenously or intramuscularly and blood sampling was performed before, 1 h and 2 h after ACTH injection. The test was performed on days 3-5 of the menstrual cycle. The following steroid hormones were assessed in the serum: 17 alpha-hydroxyprogesterone, 17 alpha-hydroxypregnenolone, dehydroepiandrosterone, testosterone, free testosterone and 5 alpha-dihydrotestosterone. The normal range was defined by the interval between the 5th and 95th percentiles; additionally the 1st, 25th, 50th, 75th and 99th percentiles are reported. A significant increase of serum hormone levels after ACTH administration could be observed for the following hormones: cortisol, 17 alpha-hydroxyprogesterone, 17 alpha-hydroxypregnenolone and dehydroepiandrosterone. There was no rise after ACTH application for testosterone, 5 alpha-dihydrotestosterone and free testosterone. It could be shown for all hormones that there was no significant difference between the serum levels that were reached after intravenous and intramuscular ACTH injection. Neither could we find a significant difference in the relative increase of the serum hormones when stimulation values were related to basal values. Since in most studies with ACTH stimulation tests, only the serum values 1 h after ACTH application are measured, we investigated whether the measurement of steroid hormones 2 h after ACTH application gave further information. We could demonstrate that for most measured serum hormones the majority of the volunteers had the maximal response 2 h after ACTH application, no matter whether ACTH was injected intramuscularly or intravenously. As a conclusion, we recommend the measurement of the respective hormones not only 1 h but also 2 h after ACTH stimulation. Since there is no increase after ACTH stimulation for total testosterone, free testosterone and 5 alpha-dihydrotestosterone, it is sufficient to assess the basal values of these hormones. Excessive adrenal response is reflected by dehydroepiandrosterone, 17 alpha-hydroxyprogesterone, 17 alpha-hydroxypregnenolone and cortisol.
内分泌检测的正常数值是识别内分泌系统紊乱的最重要前提条件。为了建立促肾上腺皮质激素（ACTH）刺激试验的参考范围，对29名无高雄激素血症的女性志愿者进行了静脉和肌肉注射ACTH刺激试验。静脉或肌肉注射总共25 IU的ACTH，并在注射前、注射后1小时和2小时进行采血。该试验在月经周期的第3 - 5天进行。检测血清中的以下类固醇激素：17α-羟孕酮、17α-羟孕烯醇酮、脱氢表雄酮、睾酮、游离睾酮和5α-双氢睾酮。正常范围由第5百分位数和第95百分位数之间的区间定义；此外，还报告了第1、25、50、75和99百分位数。ACTH给药后，以下激素的血清水平可观察到显著升高：皮质醇、17α-羟孕酮、17α-羟孕烯醇酮和脱氢表雄酮。ACTH应用后，睾酮、5α-双氢睾酮和游离睾酮没有升高。对于所有激素，静脉和肌肉注射ACTH后达到的血清水平之间没有显著差异。当刺激值与基础值相关时，我们也没有发现血清激素相对增加的显著差异。由于在大多数ACTH刺激试验研究中，仅测量ACTH应用后1小时的血清值，我们研究了ACTH应用后2小时测量类固醇激素是否能提供更多信息。我们可以证明，对于大多数测量的血清激素，无论ACTH是肌肉注射还是静脉注射，大多数志愿者在ACTH应用后2小时有最大反应。总之，我们建议不仅在ACTH刺激后1小时，而且在2小时测量相应激素。由于ACTH刺激后总睾酮、游离睾酮和5α-双氢睾酮没有升高，评估这些激素的基础值就足够了。脱氢表雄酮、17α-羟孕酮、17α-羟孕烯醇酮和皮质醇反映了肾上腺过度反应。
