Arregger Alejandro L, Cardoso Estela M L, Zucchini Alfredo, Aguirre Elvira C, Elbert Alicia, Contreras Liliana N
Endocrine Research Department, Instituto de Investigaciones Médicas A.Lanari, University of Buenos Aires, Argentina.
Unidad Ejecutora Instituto de Investigaciones Médicas, Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Laboratory of Salivary Glands, School of Dentistry, University of Buenos Aires, Argentina.
Steroids. 2014 Jun;84:57-63. doi: 10.1016/j.steroids.2014.03.008. Epub 2014 Mar 28.
Sustained hypotension among patients with end stage renal disease on dialysis (ESRDh) varies from 5.0% to 12.0%. Despite their role in the regulation of blood pressure (BP) corticoadrenal hormones have been poorly investigated.
This study aims to detect adrenal insufficiency in ESRDh and follow their clinical outcome.
Fifty ESRDh and 30 healthy volunteers were studied. In all cases basal blood and saliva were obtained. Synthetic ACTH (25μg) was injected intramuscularly and at 30min saliva was collected. Circulating ACTH, renin, cortisol and aldosterone were measured and steroids were also assessed in saliva by immunoassay.
Fifteen ESRDh achieved steroid responses not different than healthy volunteers; four had primary adrenal insufficiency; six had secondary adrenal insufficiency; nine had selective hypoaldosteronism and sixteen secondary hyperaldosteronism. The years on dialysis did not differ among subgroups. ROC analysis defined the following cut-offs for basal cortisol to predict adrenal insufficiency: in serum ⩽232.0nM (sensitivity (S) 100.0% and specificity (E) 90.0%); in saliva ⩽4.4nM (100.0% S and E). Basal aldosterone cut-off values to predict hyperaldosteronism were: in serum >500.0pM and saliva >60.0pM (100.0% S and E, for both). For the prediction of hypoaldosteronism the basal serum aldosterone was ⩽260.0pM (100% S; 53% E) and in saliva it was ⩽20.1pM (100% S; 58.5% E). Three patients with primary adrenal insufficiency and six with secondary adrenal insufficiency improved general clinical condition and normalized BP on steroids. One patient died before initiation of steroid therapy.
Adrenal function should be assessed in ESRDh in order to unmask adrenal insufficient states.
接受透析治疗的终末期肾病患者（ESRDh）中持续性低血压的发生率在5.0%至12.0%之间。尽管皮质肾上腺激素在血压（BP）调节中发挥作用，但对其研究较少。
本研究旨在检测ESRDh患者的肾上腺功能不全情况并跟踪其临床结局。
对50例ESRDh患者和30名健康志愿者进行研究。所有病例均采集基础血液和唾液样本。肌肉注射合成促肾上腺皮质激素（ACTH，25μg），30分钟后收集唾液。检测循环中的ACTH、肾素、皮质醇和醛固酮水平，并通过免疫测定法评估唾液中的类固醇。
15例ESRDh患者的类固醇反应与健康志愿者无差异；4例为原发性肾上腺功能不全；6例为继发性肾上腺功能不全；9例为选择性醛固酮减少症；16例为继发性醛固酮增多症。各亚组间透析年限无差异。ROC分析确定了预测肾上腺功能不全的基础皮质醇临界值如下：血清中≤232.0nM（敏感性（S）100.0%，特异性（E）90.0%）；唾液中≤4.4nM（S和E均为100.0%）。预测醛固酮增多症的基础醛固酮临界值为：血清中>500.0pM，唾液中>60.0pM（S和E均为100.0%）。预测醛固酮减少症时，基础血清醛固酮≤260.0pM（S为100%；E为53%），唾液中≤20.1pM（S为100%；E为58.5%）。3例原发性肾上腺功能不全患者和6例继发性肾上腺功能不全患者在接受类固醇治疗后总体临床状况改善，血压恢复正常。1例患者在开始类固醇治疗前死亡。
应评估ESRDh患者的肾上腺功能，以发现肾上腺功能不全状态。
