Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia.
Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, Maryland.
J Gerontol A Biol Sci Med Sci. 2021 Apr 30;76(5):901-905. doi: 10.1093/gerona/glaa134.
The response to adrenocorticotropic hormone (ACTH) is poorly characterized in old-old adults and may provide insight into the physiologic response to stress.
We performed a standard 250 µg ACTH stimulation test in a home-based substudy of 51 women aged 85-96 years enrolled in the Women's Health and Aging Study II who were not taking corticosteroids. We examined the cortisol and dehydroepiandrosterone (DHEA) responses at 0, 30, 60, and 120 minutes, overall and by frailty status.
The peak cortisol response to ACTH could not be determined, with the highest levels at the 120-minute time point. Pre- and post-ACTH stimulated cortisol levels did not differ by frailty status over this time frame, with no difference in the characteristics of the dose-response curves. Pre- and post-ACTH stimulated DHEA levels also did not differ by frailty status, though the dose-response curves suggested divergence after stimulation, with a more rapid DHEA response with increasing frailty.
Our data demonstrate a robust cortisol response to ACTH challenge testing, but inadequate negative feedback in old-old women, resulting in prolonged exposure to cortisol. Future studies should examine dynamic cortisol and DHEA responses in this age group, using a less potent ACTH stimulus and longer collection period.
促肾上腺皮质激素（ACTH）的反应在老老年人群中特征较差，可能深入了解应激的生理反应。
我们在 Women's Health and Aging Study II 中进行了一项基于家庭的亚研究，该研究招募了 51 名年龄在 85-96 岁之间、未服用皮质类固醇的女性，对她们进行了标准的 250µg ACTH 刺激试验。我们检查了皮质醇和脱氢表雄酮（DHEA）在 0、30、60 和 120 分钟时的反应，整体上和根据脆弱状态进行了检查。
无法确定 ACTH 对皮质醇的峰值反应，在 120 分钟时达到最高水平。在这段时间内，根据脆弱状态，ACTH 刺激前后的皮质醇水平没有差异，剂量反应曲线的特征也没有差异。ACTH 刺激前后的 DHEA 水平也没有根据脆弱状态而有所不同，尽管剂量反应曲线表明刺激后出现分歧，随着脆弱程度的增加，DHEA 反应更快。
我们的数据表明，老老年女性对 ACTH 挑战测试有强烈的皮质醇反应，但缺乏负反馈，导致皮质醇暴露时间延长。未来的研究应该使用较弱的 ACTH 刺激和更长的采集期，在该年龄组中检查动态皮质醇和 DHEA 反应。
