Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka, Japan.
J Clin Endocrinol Metab. 2019 Dec 1;104(12):5814-5822. doi: 10.1210/jc.2019-00420.
Low serum adiponectin and high-density lipoprotein-cholesterol (HDL-C) levels are risk factors for cardiovascular disease. Patients with primary adrenal insufficiency are at higher risk of cardiovascular complications compared with healthy subjects. However, there is no information on the relationship between adiponectin and glucocorticoid replacement therapy in patients with secondary adrenal insufficiency (SAI).
To determine the effects of intrinsic adrenal function and glucocorticoid replacement therapy on serum adiponectin levels and lipid profile in patients with SAI.
Part 1: a cross-sectional study. Part 2: a randomized, double-blind, crossover study.
Osaka University Hospital, Osaka, Japan.
Part 1: 58 patients diagnosed with nonfunctioning pituitary adenoma who underwent insulin tolerance test (ITT) for assessment of adrenal function. Part 2: 12 SAI patients randomly received hydrocortisone replacement therapy at a dose of 10, 20, or 30 mg/d for 4 weeks per term for three terms.
Part 1: we analyzed the relationship between serum cortisol levels during ITT and serum adiponectin levels and the lipid profile. Part 2: serum adiponectin levels and lipid profile were measured every 4 weeks.
Serum levels of adiponectin and HDL-C correlated significantly with peak cortisol levels after ITT. Serum adiponectin and HDL-C levels were significantly lower in patients with SAI than non-SAI. Serum levels of adiponectin and HDL-C increased in a hydrocortisone dose-dependent manner.
Glucocorticoid replacement therapy increased serum levels of adiponectin, an adipose-derived anti-atherogenic factor, and HDL-C in patients with SAI.
低血清脂联素和高密度脂蛋白胆固醇（HDL-C）水平是心血管疾病的危险因素。与健康受试者相比，原发性肾上腺功能不全患者发生心血管并发症的风险更高。然而，目前尚无关于继发性肾上腺功能不全（SAI）患者脂联素与糖皮质激素替代治疗之间关系的信息。
确定内在肾上腺功能和糖皮质激素替代治疗对 SAI 患者血清脂联素水平和血脂谱的影响。
第 1 部分：横断面研究。第 2 部分：随机、双盲、交叉研究。
日本大阪大学医院。
第 1 部分：58 例诊断为无功能垂体腺瘤的患者，他们接受胰岛素耐量试验（ITT）以评估肾上腺功能。第 2 部分：12 例 SAI 患者随机接受为期 4 周的 10、20 或 30 mg/d 的氢化可的松替代治疗，每个疗程 3 次。
第 1 部分：我们分析了 ITT 期间血清皮质醇水平与血清脂联素水平和血脂谱之间的关系。第 2 部分：每 4 周测量一次血清脂联素水平和血脂谱。
血清脂联素和 HDL-C 水平与 ITT 后峰值皮质醇水平显著相关。SAI 患者的血清脂联素和 HDL-C 水平明显低于非 SAI 患者。血清脂联素和 HDL-C 水平随氢化可的松剂量增加呈依赖性增加。
糖皮质激素替代治疗可增加 SAI 患者血清中脂肪源性抗动脉粥样硬化因子脂联素和 HDL-C 的水平。
