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神经性厌食症:体重减轻及恢复阶段的内分泌功能

[Anorexia nervosa: endocrine function during the phases of body weight loss and recovery].

作者信息

Méndez J P, García E, Salinas J L, Pérez-Palacios G, Ulloa-Aguirre A

出版信息

Rev Invest Clin. 1989 Oct-Dec;41(4):337-44.

PMID:2517152
Abstract

In the present study, we investigated the endocrine status of patients with anorexia nervosa during weight loss (WL), as well as, after weight recovery (WR). A comparison between our findings and those obtained from other populations previously described was made. We studied 12 female patients during WL; 7 of them were reevaluated after WR. Stimulation tests with LRH, TRH, ACTH and insulin-induced hypoglycemia were performed in all cases. During the WL phase, basal serum levels of LH and estradiol, as well as the LH response to LRH, were diminished in comparison with normal values. Basal serum levels of FSH were low or normal. The function of the hypothalamic pituitary-ovarian axis was recovered in all patients restudied; six out of seven returned to ovulation within the first 4 months after WR. The remaining patient presented hypothalamic amenorrhea because of excessive physical activity. Four patients exhibited basal low T3 and T4 levels with normal TSH and a retarded response to TRH during WL. At WR some patients completely recovered their thyroid function while others developed clinical hypothyroidism. Six months after WR all patients were euthyroid. Prolactin response to TRH was unaffected in 10 patients. One patient had basal hyperprolactinemia and hyperesponsiveness to TRH, and the remaining one had only a PRL hyperesponsiveness; this latter finding persisted in one of these patients during the WR phase. This abnormality was attributed to changes in the dopaminergic tone secondary to stress. Although serum growth hormone concentrations were normal in all patients during WL, two of them had basal hypersecretion and hyperesponsiveness to hypoglycemia during WR, which was attributed to protein deficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

在本研究中,我们调查了神经性厌食症患者体重减轻(WL)期间以及体重恢复(WR)后的内分泌状况。将我们的研究结果与先前描述的其他人群的结果进行了比较。我们研究了12名体重减轻期间的女性患者;其中7名在体重恢复后进行了重新评估。所有病例均进行了促黄体生成素释放激素(LRH)、促甲状腺激素释放激素(TRH)、促肾上腺皮质激素(ACTH)和胰岛素诱导的低血糖刺激试验。在体重减轻阶段,与正常值相比,促黄体生成素(LH)和雌二醇的基础血清水平以及LH对LRH的反应均降低。促卵泡生成素(FSH)的基础血清水平较低或正常。所有重新研究的患者下丘脑-垂体-卵巢轴功能均恢复;7名患者中有6名在体重恢复后的前4个月内恢复排卵。其余患者因过度体育活动出现下丘脑性闭经。4名患者在体重减轻期间基础甲状腺激素T3和T4水平低,促甲状腺激素(TSH)正常,对TRH反应延迟。在体重恢复时,一些患者完全恢复了甲状腺功能,而另一些患者则发展为临床甲状腺功能减退。体重恢复6个月后,所有患者甲状腺功能正常。10名患者对TRH的催乳素反应未受影响。1名患者基础催乳素血症和对TRH反应亢进,其余1名患者仅催乳素反应亢进;在体重恢复阶段,后者中的1名患者仍有此表现。这种异常归因于应激继发的多巴胺能张力变化。尽管所有患者在体重减轻期间血清生长激素浓度正常,但其中2名患者在体重恢复期间基础分泌过多且对低血糖反应亢进,这归因于蛋白质缺乏。(摘要截短于250字)

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