Arteaga E, González G, López J M, Rodríguez J A, Codner E
Departamento de Endocrinología, Metabolismo y Nutrición, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago.
Rev Med Chil. 1990 Apr;118(4):426-9.
Hypercortisolism induces a functional suppression of the hypothalamus-pituitary-adrenal axis which is expected to subside within a year following either the removal of the cortisol producing adrenal adenoma or the withdrawal of glucocorticoid therapy. We report 3 women (35, 40 and 43 years old) with Cushing's syndrome due to cortisol producing adrenal adenoma. All had typical clinical and biochemical features of the syndrome dating from up to 4 years before surgery. Cortisol supplementation was given during the postoperative period (20 mg/day po at 9 AM, reduced to 10 mg/day after 6 months). Cortisol was withdrawn 16, 20 and 39 months after surgery, when 9 AM plasma concentration raised over 10 ug/dl [corrected]. An ACTH stimulatory test was performed until a normal response was obtained. Patients showed and abnormal response up to 16, 17 and 30 months after surgery, respectively. Complete recovery took place at 21, 36, and 55 months after the operation. We concluded that risk of hypocortisolism may persist up to 30 months after surgery for cortisol producing adenomas, due to complete or partial suppression of the hypothalamus-pituitary-adrenal axis.
皮质醇增多症会导致下丘脑 - 垂体 - 肾上腺轴的功能性抑制，预计在切除产生皮质醇的肾上腺腺瘤或停用糖皮质激素治疗后的一年内这种抑制会消退。我们报告了3例因产生皮质醇的肾上腺腺瘤导致库欣综合征的女性患者（年龄分别为35岁、40岁和43岁）。她们均具有该综合征典型的临床和生化特征，这些特征可追溯至手术前长达4年的时间。术后给予皮质醇补充治疗（上午9点口服20毫克/天，6个月后减至10毫克/天）。术后16、20和39个月，当上午9点血浆皮质醇浓度升至超过10微克/分升[校正后]时停用皮质醇。进行促肾上腺皮质激素（ACTH）刺激试验，直至获得正常反应。患者分别在术后16、17和30个月时显示出异常反应。术后21、36和55个月时完全恢复。我们得出结论，由于下丘脑 - 垂体 - 肾上腺轴的完全或部分抑制，对于因产生皮质醇的腺瘤进行手术后，肾上腺皮质功能减退的风险可能会持续长达30个月。
