Kazlauskaite Rasa, Maghnie Mohamad
Endocr Dev. 2010;17:96-107. doi: 10.1159/000262532. Epub 2009 Nov 24.
The diagnosis of central adrenal insufficiency relies heavily on laboratory testing of cortisol levels in the systemic circulation. The lack of cortisol assay standardization challenges the reliability of dynamic tests of the hypothalamic-pituitary adrenal axis. Although the insulin-induced hypoglycemia or metyrapone tests remain the accepted standards for evaluating central adrenal insufficiency in children their associated risks and inconvenience make them unattractive for routine use. Corticotropin testing is an effective first step to evaluate for chronic central adrenal insufficiency for children older than 2 years who are ambulatory, have normal sleep-wake cycle and normal serum protein levels. The low-dose (1 microg) corticotropin test may be superior to standard-dose (250 mcg) for patients with suspected hypothalamic-pituitary disease.
中枢性肾上腺功能不全的诊断在很大程度上依赖于对体循环中皮质醇水平的实验室检测。皮质醇测定缺乏标准化对下丘脑 - 垂体 - 肾上腺轴动态试验的可靠性提出了挑战。尽管胰岛素诱发低血糖试验或甲吡酮试验仍是评估儿童中枢性肾上腺功能不全的公认标准，但它们相关的风险和不便使其不适合常规使用。促肾上腺皮质激素试验是评估2岁以上能够活动、睡眠 - 觉醒周期正常且血清蛋白水平正常的儿童慢性中枢性肾上腺功能不全的有效第一步。对于疑似下丘脑 - 垂体疾病的患者，低剂量（1微克）促肾上腺皮质激素试验可能优于标准剂量（250微克）试验。
