Chrousos G P, Schuermeyer T H, Doppman J, Oldfield E H, Schulte H M, Gold P W, Loriaux D L
Ann Intern Med. 1985 Mar;102(3):344-58. doi: 10.7326/0003-4819-102-3-344.
Ovine and human corticotropin-releasing factors (CRF) have similar potencies in causing adrenocorticotropic hormone (ACTH) and cortisol secretion in normal humans. Using long-acting ovine CRF (1 microgram/kg body weight as an intravenous bolus), we tested patients with Cushing's syndrome, adrenal insufficiency, and psychiatric conditions with mild hypercortisolism. Over 95% of hypercortisolemic patients with a pituitary adenoma responded with increases in plasma ACTH and cortisol concentrations; patients with the ectopic ACTH syndrome had no ACTH or cortisol responses; patients with ACTH-independent hypercortisolism of adrenal origin had low or undetectable plasma ACTH concentrations before and after CRF without any cortisol response. The differences in responses of patients with adrenal insufficiency of primary, pituitary, or suprapituitary type likewise suggest value of the CFR test in their differential diagnosis. The responses in the psychiatric patients should permit differentiation between Cushing's syndrome and hypercortisolism of psychiatric origin.
绵羊和人类促肾上腺皮质激素释放因子（CRF）在正常人体内引起促肾上腺皮质激素（ACTH）和皮质醇分泌方面具有相似的效力。使用长效绵羊CRF（1微克/千克体重静脉推注），我们对库欣综合征、肾上腺功能不全以及患有轻度皮质醇增多症的精神疾病患者进行了测试。超过95%的垂体腺瘤所致皮质醇增多症患者血浆ACTH和皮质醇浓度升高；异位ACTH综合征患者对CRF无ACTH或皮质醇反应；肾上腺源性ACTH非依赖性皮质醇增多症患者在CRF给药前后血浆ACTH浓度低或检测不到，且无皮质醇反应。原发性、垂体性或垂体上性肾上腺功能不全患者反应的差异同样表明CRF试验在其鉴别诊断中的价值。精神疾病患者的反应应有助于区分库欣综合征和精神源性皮质醇增多症。
