Boesgaard S, Hagen C, Andersen A N, Djursing H, Fenger M
Department of Internal Medicine and Endocrinology, Herlev Hospital, University of Copenhagen, Denmark.
Acta Endocrinol (Copenh). 1988 Aug;118(4):544-50. doi: 10.1530/acta.0.1180544.
Patients with functional amenorrhea have raised central dopaminergic activity and opioid-mediated GnRH inhibition leading to inhibition of hypothalamic-pituitary-ovarian function. In the present study, basal serum cortisol and ACTH levels were measured in normoprolactinemic amenorrheic patients with (N = 14) and without (N = 7) insulin-dependent diabetes mellitus. Basal serum cortisol levels was significantly (P less than 0.01) elevated in patients with normoprolactinemic amenorrhea compared with normal women. Basal serum cortisol was significantly (P less than 0.02) elevated in amenorrheic diabetic patients compared with menstruating diabetic women. In the amenorrheic groups both cortisol and ACTH levels increased significantly (P less than 0.01) after dopamine D-2 receptor blockade, whereas no hormonal changes occurred in the control groups. It is concluded that patients with normoprolactinemic amenorrhea have elevated basal serum cortisol, the reason probably being hypersecretion of corticotropin-releasing hormone. Secondly that dopaminergic blockade with metoclopramide stimulates ACTH and cortisol secretion in patients presumed to have raised dopaminergic activity.
功能性闭经患者中枢多巴胺能活性升高，且存在阿片类物质介导的促性腺激素释放激素（GnRH）抑制，导致下丘脑 - 垂体 - 卵巢功能受到抑制。在本研究中，对正常催乳素血症性闭经患者（其中患胰岛素依赖型糖尿病的有14例，未患胰岛素依赖型糖尿病的有7例）测定了基础血清皮质醇和促肾上腺皮质激素（ACTH）水平。与正常女性相比，正常催乳素血症性闭经患者的基础血清皮质醇水平显著升高（P＜0.01）。与月经正常的糖尿病女性相比，闭经的糖尿病患者基础血清皮质醇显著升高（P＜0.02）。在闭经组中，多巴胺D - 2受体阻断后皮质醇和ACTH水平均显著升高（P＜0.01），而对照组未出现激素变化。得出的结论是，正常催乳素血症性闭经患者基础血清皮质醇升高，原因可能是促肾上腺皮质激素释放激素分泌过多。其次，对于推测多巴胺能活性升高的患者，用甲氧氯普胺进行多巴胺能阻断可刺激ACTH和皮质醇分泌。
