Harrison B D, Rees L H, Cayton R M, Nabarro J D
Clin Endocrinol (Oxf). 1982 Aug;17(2):109-18. doi: 10.1111/j.1365-2265.1982.tb01570.x.
Hypothalamo-pituitary--adrenal (HPA) function was studied using tetracosactrin and insulin hypoglycemia tests in eleven asthmatic patients who were receiving or had taken oral steroids. The patients had been on prednisone, 5--20 mg/day for 2--17 years. As the dose was reduced they used beclomethasone inhalation, up to 800 micrograms/day. Seven insulin hypoglycemia tests were performed when the patients had been off oral steroids for 15--37 months. Plasma cortisol responses were normal in all seven, three had subnormal responses of ACTH. In five patients serial tetracosactrin and insulin hypoglycaemia tests were performed during reduction of steroid dose. Two patterns of recovery of HPA function were observed. In one, both hypothalamo--pituitary and adrenal function seemed to return simultaneously, in the other normal response to tetracosactrin appeared before that to insulin hypoglycaemia. One patient had normal ACTH and cortisol responses to the stress of a vasovagal attack, but failed to respond to subsequent hypoglycaemia. We conclude that a normal response to tetracosactrin does not indicate recovery of the HPA axis after stopping prolonged oral steroid therapy for asthma, and that patients should continue to carry steroid therapy cards for at least 5 years after such treatment has been discontinued.
采用二十四肽促皮质素和胰岛素低血糖试验，对11例正在接受或曾服用口服类固醇的哮喘患者的下丘脑 - 垂体 - 肾上腺（HPA）功能进行了研究。这些患者服用泼尼松剂量为5 - 20mg/天，疗程为2 - 17年。随着剂量减少，他们使用倍氯米松吸入剂，剂量高达800微克/天。在患者停用口服类固醇15 - 37个月后进行了7次胰岛素低血糖试验。所有7例患者的血浆皮质醇反应均正常，其中3例促肾上腺皮质激素（ACTH）反应低于正常。对5例患者在减少类固醇剂量期间进行了连续的二十四肽促皮质素和胰岛素低血糖试验。观察到HPA功能恢复的两种模式。一种模式是下丘脑 - 垂体和肾上腺功能似乎同时恢复，另一种模式是对二十四肽促皮质素的正常反应先于对胰岛素低血糖的反应出现。1例患者对血管迷走神经性发作应激的ACTH和皮质醇反应正常，但对随后的低血糖无反应。我们得出结论，对二十四肽促皮质素的正常反应并不表明在停止长期口服类固醇治疗哮喘后HPA轴已恢复，并且患者在停止此类治疗后应继续携带类固醇治疗卡至少5年。
