König S A, Schmidt H, Rauh W, Vecsei P
Monatsschr Kinderheilkd. 1986 Aug;134(8):527-30.
In 20 juvenile diabetic inpatients the relationship between nocturnal hypoglycemia and overnight urinary cortisol excretion was studied. Cortisol was expressed as absolute quantity per kg body weight because the cortisol/creatinine ratio does not always yield reliable results in diabetic patients. Comparison between different patients yielded no significant difference between posthypoglycemic and non-posthypoglycemic cortisol values. Testing the difference between urinary cortisol excretion in posthypoglycemic and non-posthypoglycemic urine samples for every one of the patients intraindividually, however, a significant posthypoglycemic elevation was found. Posthypoglycemic cortisol response was irregular and variable not only in different patients, but also within the same patient. If a high excretion of cortisol is found in an overnight urine sample, it is very likely to be caused by nocturnal hypoglycemia. On the other hand it is impossible to exclude nocturnal hypoglycemia by normal urinary cortisol findings. Reactive hyperglycemia as described by Somogyi was seen only rarely in this study. It is concluded that even if a distortion by falsely high creatinine measurements in diabetics is ruled out, cortisol measurement in overnight urine samples cannot be used as easy routine method for the detection of nocturnal hypoglycemia.
对20名青少年糖尿病住院患者夜间低血糖与夜间尿皮质醇排泄之间的关系进行了研究。皮质醇以每千克体重的绝对量表示，因为皮质醇/肌酐比值在糖尿病患者中并不总是能得出可靠的结果。不同患者之间的比较显示，低血糖后和非低血糖后的皮质醇值无显著差异。然而，对每位患者低血糖后和非低血糖后尿样中的尿皮质醇排泄差异进行个体内测试时，发现低血糖后有显著升高。低血糖后皮质醇反应不仅在不同患者中不规则且多变，在同一患者体内也是如此。如果在夜间尿样中发现皮质醇排泄量高，很可能是由夜间低血糖引起的。另一方面，尿皮质醇结果正常也不能排除夜间低血糖。本研究中很少见到索莫吉描述的反应性高血糖。得出的结论是，即使排除了糖尿病患者肌酐测量值假性偏高造成的偏差，夜间尿样中的皮质醇测量也不能作为检测夜间低血糖的简便常规方法。
