Worgul T J, Santen R J, Samojlik E, Wells S A
J Clin Endocrinol Metab. 1982 Jan;54(1):22-6. doi: 10.1210/jcem-54-1-22.
Surgical adrenalectomy produces objective tumour regression in 50-60% of estrogen receptor-positive women with metastatic breast carcinoma. Additional responses to antiestrogens or further suppression of estrogens with aminoglutethimide after adrenalectomy suggest the possibility of continued adrenal steroid secretion even after surgical ablation. The use of sensitive and specific RIAs allows precise determination of the degree of hormone suppression after adrenalectomy and could provide documentation of nonsuppression or escape from suppression in individual patients. To evaluate the possibility of continued hormone secretion, we measured 14 hormones in 26 postmenopausal women with breast carcinoma before and after adrenalectomy. While the mean levels of androgens were markedly suppressed [dehydroepiandrosterone sulfate (DHEA-S), 99%, androstenedione, 94%; testosterone, 77%; dihydrotestosterone, 73%] after adrenalectomy, estrogen concentrations fell to a much lesser extent (plasma estrone, 73%; urinary estrone, 86%; plasma estradiol, 53%; urinary estradiol, 67%). Examination of data in individual patients revealed incomplete suppression in several women (less than 50% suppression of plasma estradiol in 14 of 25 patients, of urinary estradiol in 4 of 22, and of urinary estrone in 1 of 22). Androgen concentrations also fell incompletely after adrenalectomy in a few patients. Androstenedione concentrations were greater than 2 SD above the group mean in 2 of 23 patients, and in 2 of 25 patients, DHEA-S concentrations were also greater that 2 SD above the group mean. Serial measurements of hormones over a 1- to 3-yr period following surgery revealed escape from suppression over time (i.e. greater than 2-fold increase in hormone levels) in 7 of 26 women. The practical significance of the lack of suppression or of escape from inhibition was assessed by comparing estrogen levels in responders vs. nonresponders to surgical adrenalectomy. Of all steroids measured, greater suppression of only 1 hormone (urinary estrone) was observed in responders vs. nonresponders. These data indicate that adrenalectomy does not uniformly suppress circulating androgen and estrogen levels in postmenopausal patients. Women who initially suppress after adrenalectomy may show recovery of either androgen or estrogen levels with time.
手术切除肾上腺可使50% - 60%雌激素受体阳性的转移性乳腺癌女性患者的肿瘤客观消退。肾上腺切除术后对抗雌激素有额外反应或用氨鲁米特进一步抑制雌激素，提示即使在手术切除后仍可能持续分泌肾上腺类固醇。使用灵敏且特异的放射免疫分析法（RIA）可精确测定肾上腺切除术后激素抑制的程度，并可为个体患者未被抑制或逃脱抑制提供证据。为评估持续激素分泌的可能性，我们测定了26例绝经后乳腺癌女性患者肾上腺切除术前、后的14种激素。肾上腺切除术后，雄激素的平均水平显著降低[硫酸脱氢表雄酮（DHEA - S）降低99%，雄烯二酮降低94%；睾酮降低77%；双氢睾酮降低73%]，而雌激素浓度下降幅度小得多（血浆雌酮降低73%；尿雌酮降低86%；血浆雌二醇降低53%；尿雌二醇降低67%）。对个体患者数据的检查发现，数名女性的激素抑制不完全（25例患者中有14例血浆雌二醇抑制不足50%，22例中有4例尿雌二醇抑制不足50%，22例中有1例尿雌酮抑制不足50%）。少数患者肾上腺切除术后雄激素浓度下降也不完全。23例患者中有2例雄烯二酮浓度高于组均值2个标准差以上，25例患者中有2例DHEA - S浓度也高于组均值2个标准差以上。术后1至3年对激素进行连续测量发现，26例女性中有7例随着时间推移激素水平逃脱抑制（即激素水平增加超过2倍）。通过比较手术切除肾上腺的反应者与无反应者的雌激素水平，评估了缺乏抑制或逃脱抑制的实际意义。在所有测定的类固醇中，反应者与无反应者相比，仅观察到1种激素（尿雌酮）受到更大程度的抑制。这些数据表明，肾上腺切除术不能一致地抑制绝经后患者循环中的雄激素和雌激素水平。肾上腺切除术后最初受到抑制的女性，随着时间推移可能出现雄激素或雌激素水平的恢复。
