Nieman L K, Cutler G B, Oldfield E H, Loriaux D L, Chrousos G P
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892.
J Clin Endocrinol Metab. 1989 Jul;69(1):165-9. doi: 10.1210/jcem-69-1-165.
The ovine CRH (oCRH) stimulation test is useful in distinguishing Cushing's disease from the syndrome of ectopic ACTH secretion. Most patients with Cushing's disease have increased plasma ACTH and cortisol responses to oCRH, while patients with the ectopic ACTH syndrome do not. We predicted that the homologous hormone human CRH (hCRH) might be an equally useful diagnostic agent, with the theoretic advantage of being less immunogenic. This study compared the responses to hCRH and oCRH (1 microgram/kg, iv) in 15 patients with Cushing's disease. Plasma ACTH and cortisol levels increased in most patients during the first hour after administration of either hCRH or oCRH. However, the peak and time-integrated hormonal responses to hCRH were smaller than the responses to oCRH. All but 1 patient had an ACTH and/or cortisol response to oCRH that exceeded 4 times the intraassay coefficient of variation. Three patients had neither an ACTH nor a cortisol response to hCRH by the same criterion. Thus, when administered at equivalent doses, hCRH is a less effective stimulus of ACTH and cortisol secretion in patients with Cushing's disease. Based upon the observation that the oCRH stimulation test has greater sensitivity than the hCRH stimulation test for the diagnosis of Cushing's disease, we conclude that oCRH is the preferred analog to use for CRH testing in patients with Cushing's syndrome.
绵羊促肾上腺皮质激素释放激素（oCRH）刺激试验有助于鉴别库欣病与异位促肾上腺皮质激素（ACTH）分泌综合征。大多数库欣病患者对oCRH的血浆ACTH和皮质醇反应增强，而异位ACTH综合征患者则不然。我们预测，同源激素人促肾上腺皮质激素释放激素（hCRH）可能是一种同样有用的诊断剂，理论上具有免疫原性较低的优势。本研究比较了15例库欣病患者对hCRH和oCRH（1微克/千克，静脉注射）的反应。在给予hCRH或oCRH后的第一小时内，大多数患者的血浆ACTH和皮质醇水平升高。然而，hCRH的激素反应峰值和时间积分反应均小于oCRH。除1例患者外，所有患者对oCRH的ACTH和/或皮质醇反应均超过测定内变异系数的4倍。按照相同标准，3例患者对hCRH既无ACTH反应也无皮质醇反应。因此，当给予等效剂量时，hCRH对库欣病患者ACTH和皮质醇分泌的刺激作用较小。基于oCRH刺激试验对库欣病诊断的敏感性高于hCRH刺激试验这一观察结果，我们得出结论，oCRH是库欣综合征患者CRH检测中首选的类似物。
