Müller O A, Stalla G K, von Werder K
Horm Res. 1987;25(4):185-98. doi: 10.1159/000180652.
A stimulation test with 100 micrograms ovine or human corticotropin-releasing factor (CRF) is a useful diagnostic tool in diseases of the hypothalamo-pituitary-adrenal axis. No serious side effects were observed during the test procedure. The results showed that the CRF test is useful in making the differential diagnosis of established Cushing's syndrome (n = 42). The CRF test was also repeated after transsphenoidal surgery in 25 patients with Cushing's disease. Successfully operated patients exhibit no, blunted or normal adrenocorticotropic hormone (ACTH) responses to CRF (n = 15), whereas patients who did not show remission remained hyperresponsive (n = 10). In patients with autonomous adrenal cortisol secretion, the ACTH response to CRF was suppressed (n = 10). After surgery the ACTH response to CRF can already be demonstrated when cortisol levels are still undetectable. Pulsatile administration of CRF in one patient after unilateral adrenalectomy and another patient under corticoid therapy revealed that ACTH responses to CRF normalize rapidly but cannot be sustained if CRF administration is withdrawn, suggesting that the cause of adrenal failure after unilateral adrenalectomy for Cushing's syndrome or long-term corticoid therapy is due to hypothalamic CRF deficiency. The decrease of the ACTH responses to CRF in glucocorticoid-treated patients correlated directly to the daily corticoid dosage. Since the ACTH hyperresponse to CRF in 6 patients with Cushing's disease was also suppressed by short-term dexamethasone treatment, the pituitary level as target site for the acute feedback inhibition is also demonstrated. The evaluation of the CRF-induced ACTH response in patients with secondary adrenal failure without detectable pathology in the sella and suprasellar region (n = 6) enables the differentiation between hypothalamic and pituitary adrenal insufficiency. In patients with hypothalamic lesions the ACTH response to CRF was normal whereas insulin hypoglycemia failed to induce an ACTH rise.
用100微克绵羊或人促肾上腺皮质激素释放因子（CRF）进行刺激试验，是下丘脑 - 垂体 - 肾上腺轴疾病的一种有用诊断工具。在试验过程中未观察到严重副作用。结果表明，CRF试验有助于对确诊的库欣综合征（n = 42）进行鉴别诊断。对25例库欣病患者在经蝶窦手术后也重复进行了CRF试验。手术成功的患者对CRF无、迟钝或正常的促肾上腺皮质激素（ACTH）反应（n = 15），而未显示缓解的患者仍有高反应性（n = 10）。在自主性肾上腺皮质醇分泌患者中，ACTH对CRF的反应受到抑制（n = 10）。手术后，当皮质醇水平仍不可检测时，ACTH对CRF的反应就已能表现出来。在一名单侧肾上腺切除术后的患者和另一名接受皮质类固醇治疗的患者中，脉冲式给予CRF显示，ACTH对CRF的反应迅速恢复正常，但如果停止给予CRF则不能维持，这表明因库欣综合征行单侧肾上腺切除术后或长期皮质类固醇治疗导致肾上腺功能衰竭的原因是下丘脑CRF缺乏。糖皮质激素治疗患者中ACTH对CRF反应的降低与每日皮质类固醇剂量直接相关。由于短期地塞米松治疗也抑制了6例库欣病患者中ACTH对CRF的高反应，这也证明了垂体水平是急性反馈抑制的靶位点。对蝶鞍和鞍上区域无明显病变的继发性肾上腺功能衰竭患者（n = 6）进行CRF诱导的ACTH反应评估，能够区分下丘脑性和垂体性肾上腺功能不全。下丘脑病变患者对CRF的ACTH反应正常，而胰岛素低血糖未能诱导ACTH升高。
