Hermus A R, Pieters G F, Pesman G J, Meijer E, Smals A G, Benraad T J, Kloppenborg P W
Department of Medicine, University of Nijmegen, The Netherlands.
J Endocrinol Invest. 1987 Aug;10(4):365-9. doi: 10.1007/BF03348149.
The type of secondary adrenal failure, which occurs after successful pituitary surgery in Cushing's disease was studied using CRH administration. Eight patients with Cushing's disease were studied in the immediate postoperative period (9-18 days) of successful pituitary surgery. The results in these patients were compared with those in 13 healthy subjects, 7 patients with secondary adrenal failure of the pituitary type and 9 patients with secondary adrenal failure of the hypothalamic type. In all postoperative patients with Cushing's disease, except one, clear ACTH and cortisol responses occurred after CRH, demonstrating hypothalamic adrenal failure in these patients. This demonstration of hypothalamic adrenal failure after neurosurgery strongly argues against a pivotal role for endogenous CRH in the pathogenesis of Cushing's disease in these patients. The mean ACTH response to CRH in the postoperative patients with Cushing's disease was significantly lower than that in patients with adrenal failure of the hypothalamic type. This suggests the presence of pituitary failure in the postadenomectomy patients. In conclusion, this study provides arguments that the secondary adrenal failure after adenomectomy in Cushing's disease is caused by both hypothalamic and pituitary failure.
利用促肾上腺皮质激素释放激素（CRH）给药对库欣病患者垂体手术成功后发生的继发性肾上腺功能减退类型进行了研究。对8例库欣病患者在垂体手术成功后的术后即刻（9 - 18天）进行了研究。将这些患者的结果与13名健康受试者、7例垂体型继发性肾上腺功能减退患者和9例下丘脑型继发性肾上腺功能减退患者的结果进行了比较。在所有术后库欣病患者中，除1例患者外，CRH给药后均出现明显的促肾上腺皮质激素（ACTH）和皮质醇反应，表明这些患者存在下丘脑性肾上腺功能减退。神经外科手术后下丘脑性肾上腺功能减退的这一表现有力地反驳了内源性CRH在这些患者库欣病发病机制中起关键作用的观点。术后库欣病患者对CRH的平均ACTH反应明显低于下丘脑型肾上腺功能减退患者。这表明腺瘤切除术后患者存在垂体功能减退。总之，本研究表明库欣病腺瘤切除术后的继发性肾上腺功能减退是由下丘脑和垂体功能减退共同引起的。
