Pang S Y, Legido A, Levine L S, Temeck J W, New M I
J Clin Endocrinol Metab. 1987 Aug;65(2):282-9. doi: 10.1210/jcem-65-2-282.
We determined the adrenal steroid responses to metyrapone, ACTH, and CRH in 12 ACTH-intact and 5 ACTH-deficient hypopituitary children to determine the mechanisms that control adrenal androgen secretion. Serum adrenal androgen concentrations [dehydroepiandrosterone (DHEA) and delta 4-androstenedione (delta 4-A)] rose in response to oral administration of metyrapone (450 mg/m2 X dose, every h for 7 doses) in ACTH-intact hypopituitary children with multiple or isolated pituitary hormone deficiencies [mean postmaryrapone level: DHEA, 225 ng/dL (range, 27-566); delta 4-A, 313 ng/dL (range, 105-651)], except in 2 young children in whom DHEA did not rise. These adrenal androgens did not rise in all ACTH-deficient hypopituitary children [mean postmetyrapone level: DHEA, 11.0 ng/dL (range, 3-16); delta 4-A, 6.2 ng/dL (range, 3-10)]. The increases in both serum cortisol and adrenal androgens, including DHEA sulfate, in response to short term ACTH infusion (40 U in 6 h) in ACTH-intact hypopituitary children were normal or above normal, while these steroid responses were significantly (P less than 0.05-0.01) lower in ACTH-deficient hypopituitary children compared to normal values. However, prolonged administration of ACTH (40 U/day, or im) for 6 days to 2 ACTH-deficient hypopituitary children resulted in normal DHEA responses to the 6-h ACTH stimulation test (DHEA levels after the first test, 14 and 30 ng/dL, after priming, 80 and 50 ng/dL). Furthermore, CRH administration to 4 ACTH-deficient patients caused a rise in serum DHEA and cortisol in patients with a normal ACTH response, while those with a poor ACTH response had a lesser rise in DHEA and cortisol. These data suggest that ACTH is the major tropic hormone for adrenal androgen secretion.
我们测定了12名促肾上腺皮质激素（ACTH）功能正常和5名ACTH缺乏的垂体功能减退儿童对甲吡酮、促肾上腺皮质激素（ACTH）和促肾上腺皮质激素释放激素（CRH）的肾上腺类固醇反应，以确定控制肾上腺雄激素分泌的机制。在患有多种或单一垂体激素缺乏的ACTH功能正常的垂体功能减退儿童中，口服甲吡酮（450mg/m²×剂量，每小时1次，共7次）后，血清肾上腺雄激素浓度[脱氢表雄酮（DHEA）和δ4-雄烯二酮（δ4-A）]升高[甲吡酮给药后平均水平：DHEA，225ng/dL（范围27-566）；δ4-A，313ng/dL（范围105-651）]，但有2名幼儿的DHEA未升高。在所有ACTH缺乏的垂体功能减退儿童中，这些肾上腺雄激素并未升高[甲吡酮给药后平均水平：DHEA，11.0ng/dL（范围3-16）；δ4-A，6.2ng/dL（范围3-10）]。在ACTH功能正常的垂体功能减退儿童中，短期输注ACTH（6小时内40U）后，血清皮质醇和肾上腺雄激素（包括硫酸脱氢表雄酮）的升高正常或高于正常水平，而与正常值相比，ACTH缺乏的垂体功能减退儿童的这些类固醇反应显著降低（P<0.05-0.01）。然而，对2名ACTH缺乏的垂体功能减退儿童持续6天给予ACTH（40U/天，或皮下注射），导致DHEA对6小时ACTH刺激试验的反应正常（第一次试验后DHEA水平分别为14和30ng/dL，预激后为80和50ng/dL）。此外，对4名ACTH缺乏患者给予CRH后，ACTH反应正常的患者血清DHEA和皮质醇升高，而ACTH反应较差的患者DHEA和皮质醇升高幅度较小。这些数据表明，ACTH是肾上腺雄激素分泌的主要促激素。
