Puig M L, Webb S M, del Pozo C, Espinosa J R, Martínez M J, de Leiva A
Acta Endocrinol (Copenh). 1986 Mar;111(3):296-9. doi: 10.1530/acta.0.1110296.
A 35 year old woman suffering from ACTH and prolactin (Prl) deficiency is described. Her symptoms of adrenal insufficiency appeared gradually after her first pregnancy in 1970; however, she conceived twice more and delivered healthy babies in 1972 and 1974, which she could not breast feed due to lack of milk. During an episode of pneumonia in 1977 she suffered acute adrenal insufficiency, after which she began treatment with hydrocortisone. Her pituitary reserve for TSH, GH, LH and FSH was normal, but her ACTH and Prl levels were undectable and did not respond to acute iv challenges of corticotrophin-releasing factor (CRF) and TRH, respectively. Autoantibodies, including antilactotroph titres, were negative, except for a positive pituitary immunofluorescence to ACTH. There was also no ACTH stimulation to a prolonged infusion of CRF followed by an acute iv bolus. These results, together with the gradual onset of symptoms which worsened after each pregnancy, suggest a possible autoimmune aetiology of her pituitary ACTH and Prl deficiencies.
本文描述了一名35岁患有促肾上腺皮质激素（ACTH）和催乳素（Prl）缺乏症的女性。她的肾上腺功能不全症状在1970年首次怀孕后逐渐出现；然而，她在1972年和1974年又怀孕两次并产下健康婴儿，但由于乳汁缺乏无法进行母乳喂养。1977年患肺炎期间，她出现急性肾上腺功能不全，此后开始接受氢化可的松治疗。她垂体对促甲状腺激素（TSH）、生长激素（GH）、促黄体生成素（LH）和促卵泡生成素（FSH）的储备正常，但ACTH和Prl水平检测不到，且分别对促肾上腺皮质激素释放因子（CRF）和促甲状腺激素释放激素（TRH）的急性静脉注射刺激无反应。自身抗体，包括抗催乳素细胞抗体滴度均为阴性，但垂体对ACTH的免疫荧光检测呈阳性。长时间输注CRF后再进行急性静脉推注，也未出现ACTH刺激反应。这些结果，连同症状在每次怀孕后逐渐出现且加重的情况，提示其垂体ACTH和Prl缺乏可能存在自身免疫病因。
