Raff H
Am J Physiol. 1987 Apr;252(4 Pt 2):R635-44. doi: 10.1152/ajpregu.1987.252.4.R635.
Several lines of evidence have suggested that neurohypophysial vasopressin secretion is under the influence of glucocorticoid negative feedback. Studies in clinical and experimental adrenal insufficiency have suggested that the impaired water excretion accompanying that syndrome may be due to elevated vasopressin levels. Furthermore, both the impaired water excretion and elevated vasopressin levels observed in adrenal insufficiency may be normalized by glucocorticoid treatment. This topic remains controversial, with a considerable body of evidence suggesting that vasopressin is elevated during adrenal insufficiency not because of a loss of central steroid negative feedback but because of alterations in plasma volume osmolality (renal mechanisms). Vasopressin responses to a variety of stimuli (hemorrhage, hypoxia, hypertonic saline) in normal humans and animals appear to be attenuated or eliminated by pretreatment with glucocorticoids. However, the vasopressinergic system appears to be considerably less sensitive to negative feedback than the corticotropin-releasing factor-adrenocorticotropic hormone (ACTH) system. There is evidence that the locus for this inhibitory effect is both directly at the posterior pituitary and within the hypothalamus. It is unlikely that corticosteroid negative feedback closes a direct hypothalamo-neurohypophysial-adrenocortical feedback loop. Since neurohypophysial vasopressin is involved in the control of ACTH secretion, it is more likely that the modulation of neurohypophysial vasopressin by glucocorticoid is an integral part of the overall negative-feedback control of ACTH secretion. The physiological role of glucocorticoid inhibition of vasopressin secretion remains speculative.
多条证据表明,神经垂体抗利尿激素的分泌受糖皮质激素负反馈的影响。临床和实验性肾上腺功能不全的研究表明,该综合征伴随的水排泄受损可能是由于抗利尿激素水平升高所致。此外,肾上腺功能不全时观察到的水排泄受损和抗利尿激素水平升高,均可通过糖皮质激素治疗恢复正常。这个话题仍存在争议,大量证据表明,肾上腺功能不全时抗利尿激素升高并非因为中枢类固醇负反馈丧失,而是由于血浆渗透压(肾脏机制)改变。在正常人和动物中,糖皮质激素预处理似乎会减弱或消除抗利尿激素对多种刺激(出血、缺氧、高渗盐水)的反应。然而,抗利尿激素能系统似乎比促肾上腺皮质激素释放因子-促肾上腺皮质激素(ACTH)系统对负反馈的敏感性低得多。有证据表明,这种抑制作用的位点既直接位于垂体后叶,也位于下丘脑内。皮质类固醇负反馈不太可能闭合直接的下丘脑-神经垂体-肾上腺皮质反馈回路。由于神经垂体抗利尿激素参与促肾上腺皮质激素分泌的控制,糖皮质激素对神经垂体抗利尿激素分泌的调节更有可能是促肾上腺皮质激素分泌整体负反馈控制的一个组成部分。糖皮质激素抑制抗利尿激素分泌的生理作用仍属推测。