Schürmeyer T H, Tsokos G C, Avgerinos P C, Balow J E, D'Agata R, Loriaux D L, Chrousos G P
J Clin Endocrinol Metab. 1985 Jul;61(1):22-7. doi: 10.1210/jcem-61-1-22.
We examined the responsiveness of the pituitary-adrenal axis to ovine corticotropin-releasing hormone (oCRH) in 14 women with systemic lupus erythematosus receiving chronic, alternate day glucocorticoid therapy with prednisone. Testing was done twice and in a random order (at 2000 h) on the day when the steroid was taken (12 h after the last dose) and on the day when no glucocorticoid was administered (36 h after the last dose). Plasma ACTH and cortisol responses were markedly blunted on the day of treatment and mildly blunted on the day off treatment compared to those in normal subjects. Altered metabolic clearance of exogenous oCRF was not responsible for this difference, since the plasma disappearance curves of immunoreactive oCRH were similar on both days. The degree of suppression was dependent on the dose of prednisone, and the amount of cortisol secreted during the oCRH test was directly proportional to the logarithm of the concurrent plasma ACTH level. Thus, the cortisol response to ACTH was normal in all patients. These data suggest that the blunting of responsiveness to oCRH on both days of testing represents prednisolone suppression of the corticotroph cell. Despite this, the adrenal glands retain normal responsiveness to ACTH, suggesting that moderate decreases in daily ACTH secretion are compatible with sustaining normal adrenal function. Hence, the site of the mild suppression of the hypothalamic-pituitary-adrenal axis during chronic, alternate day treatment with glucocorticoids is central, whereas the adrenal glands appear to remain functionally unaffected.
我们检测了14名接受泼尼松隔日慢性糖皮质激素治疗的系统性红斑狼疮女性患者垂体 - 肾上腺轴对羊促肾上腺皮质激素释放激素（oCRH）的反应性。在服用类固醇药物当天（最后一剂后12小时）和未服用糖皮质激素当天（最后一剂后36小时），于2000时进行了两次随机测试。与正常受试者相比，治疗当天血浆促肾上腺皮质激素（ACTH）和皮质醇反应明显减弱，停药当天反应轻度减弱。外源性oCRF代谢清除的改变并非造成这种差异的原因，因为免疫反应性oCRH的血浆消失曲线在两天相似。抑制程度取决于泼尼松的剂量，oCRH测试期间分泌的皮质醇量与同期血浆ACTH水平的对数成正比。因此，所有患者对ACTH的皮质醇反应均正常。这些数据表明，测试两天中对oCRH反应性的减弱代表泼尼松龙对促肾上腺皮质激素细胞的抑制。尽管如此，肾上腺对ACTH仍保持正常反应性，这表明每日ACTH分泌的适度减少与维持正常肾上腺功能是相容的。因此，在糖皮质激素隔日慢性治疗期间，下丘脑 - 垂体 - 肾上腺轴轻度抑制的部位在中枢，而肾上腺似乎在功能上未受影响。
