Stokes P E, Sikes C R
Cornell University Medical College, New York, New York.
Endocrinol Metab Clin North Am. 1988 Mar;17(1):1-19.
The clinical utility of the tests of hypothalamic-pituitary-adrenocortical function discussed in this article are still to be ascertained. As with the dexamethasone suppression test, reviewed elsewhere in this issue, the application of other basal and challenge tests have furthered our understanding of the character of observed hypothalamic-pituitary-adrenocortical function in psychiatric patients. Hypothalamic-pituitary-adrenocortical physiology is complex and plastic and cannot be understood in terms of oversimplified explanations or concepts. Repeated measures over time, involving multiple assessments of axis activity, are essential in understanding the modulating effects of prior activity of the system (induced by endogenous regulatory systems or by superimposed environmental stressors) on the current function of the various levels in this closed-loop axis, where all parts influence the function of the remainder. From such an appreciation and understanding of this system can come more simplified assessments of its function, which would allow application to clinical psychiatry.
本文所讨论的下丘脑 - 垂体 - 肾上腺皮质功能测试的临床效用仍有待确定。正如本期其他地方所回顾的地塞米松抑制试验一样，其他基础试验和激发试验的应用加深了我们对精神病患者下丘脑 - 垂体 - 肾上腺皮质功能特征的理解。下丘脑 - 垂体 - 肾上腺皮质生理学复杂且具有可塑性，不能通过过于简单的解释或概念来理解。随着时间的重复测量，包括对该轴活动的多次评估，对于理解该系统先前活动（由内源性调节系统或叠加的环境应激源诱导）对这个闭环轴中各个水平当前功能的调节作用至关重要，在这个闭环轴中，所有部分都会影响其余部分的功能。从对这个系统的这种认识和理解中，可以得出对其功能更简化的评估，这将有助于应用于临床精神病学。
