Department of Medicine E, Kfar Saba, Israel, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Clin Pract. 2010 Sep;64(10):1398-401. doi: 10.1111/j.1742-1241.2010.02466.x.
Hypothalamic-pituitary-adrenal (HPA) axis insufficiency is the most common endocrine disorder in patients with antiphospholipid syndrome (APS). Primary adrenal failure because of venous thrombosis and/or adrenal haemorrhage is the leading diagnosis, while another possible mechanism is autoimmune adrenal failure. Prospective evaluation of the HPA axis in patients with APS has not been previously performed.
To evaluate the HPA axis in patients with APS.
Ambulatory patients (age 18 years and older) with APS were given a symptom questionnaire. Baseline aldosterone, corticotropin (ACTH) and adrenal cortex autoantibodies (ACA) were measured. Cortisol was measured at baseline and after 1-mcg ACTH stimulation.
In all, 24 patients (18 women/6 men; mean age 44.6 +/- 16.1 years) participated in the study. Of these, 21 had primary APS with disease duration of 5.8 +/- 6.2 years. Baseline cortisol level was 12.6 +/- 4.2 mg/dl (normal 7-25). After ACTH stimulation, it was 24.7 +/- 4.1 mg/dl and 22.8 +/- 7.4 mg/dl at 30 and 60 min respectively. All patients had a stimulated cortisol level of at least 18 mg/dl, although three patients had stimulated cortisol between 18 and 20 mg/dl, one of which reported previous inhaled steroid treatment. Weakness, dizziness and nausea were reported at baseline by 50%, 38% and 25% of the patients respectively. ACA were negative in all patients examined.
In our cohort, patients with APS did not have HPA axis insufficiency. Partial adrenal insufficiency could not be excluded in two patients. Further longitudinal studies are needed to determine the significance of periodic evaluation of the HPA axis in patients with APS.
抗磷脂综合征（APS）患者最常见的内分泌紊乱是下丘脑-垂体-肾上腺（HPA）轴功能不全。由于静脉血栓形成和/或肾上腺出血导致原发性肾上腺功能衰竭是主要诊断，而另一种可能的机制是自身免疫性肾上腺功能衰竭。以前没有对 APS 患者的 HPA 轴进行前瞻性评估。
评估 APS 患者的 HPA 轴。
对患有 APS 的门诊患者（年龄 18 岁及以上）进行症状问卷评估。测量基线醛固酮、促肾上腺皮质激素（ACTH）和肾上腺皮质自身抗体（ACA）。在基线和 1-mcg ACTH 刺激后测量皮质醇。
共有 24 名患者（18 名女性/6 名男性；平均年龄 44.6 +/- 16.1 岁）参与了这项研究。其中 21 名患有原发性 APS，疾病持续时间为 5.8 +/- 6.2 年。基线皮质醇水平为 12.6 +/- 4.2 mg/dl（正常范围 7-25）。ACTH 刺激后，30 分钟和 60 分钟时分别为 24.7 +/- 4.1 mg/dl 和 22.8 +/- 7.4 mg/dl。所有患者的皮质醇刺激水平均至少为 18 mg/dl，尽管有 3 名患者的皮质醇刺激水平在 18-20 mg/dl 之间，其中 1 名患者曾报告吸入性皮质类固醇治疗。50%、38%和 25%的患者分别在基线时报告有乏力、头晕和恶心。所有检查的患者 ACA 均为阴性。
在我们的队列中，APS 患者没有 HPA 轴功能不全。两名患者可能存在部分肾上腺功能不全。需要进一步的纵向研究来确定定期评估 APS 患者 HPA 轴的意义。
