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[肾上腺皮质移植。人类库欣综合征和原发性醛固酮增多症的动物实验模型——肾上腺皮质移植的临床方面]

[Adrenal cortex transplantation. Animal experimental models for the human Cushing and Conn syndromes--clinical aspects of adrenal cortex transplantation].

作者信息

Klempa I, Schwedes U, Steinau U, Schneider M, Röttger P, Usadel K H

出版信息

Chirurg. 1980 Oct;51(10):634-43.

PMID:7002496
Abstract

Thymusaplastic mutants of mice (nu/nu) and rats (rnu/rnu) were used as recipients for tissue of one aldosteronoma of a 21-year-old male patient with Conn's syndrome and for tissue of one adenoma of a 28-year-old female patient with Cushing's syndrome. In this animal experimental study we succeeded in demonstrating that congenitally athymic rodents are ideal recipients for xenotransplantation of adrenal cortical tissue. The graft viability was demonstrated by obtaining light and electron micrographs of the biopsied transplants and its endocrine function documented by the measurements of plasma renin, cortisol, and urinary excretion of aldosterone, cortisol, and corticosterone. Fifteen patients are presented who were surgically treated for Cushing's disease. Fourteen patients with adrenocortical hyperplasia underwent total adrenalectomy and two had after adrenalectomy autotransplantation of adrenal tissue in the forearm muscle. One patient was treated with a transsphenoidal, partial hypophysectomy. Our clinical experience with Cushing's disease showed that the initial surgical procedure may be directed to the pituitary and only in unsuccessful surgery to the adrenals. Adrenal autotransplantation after total adrenalectomy is an obsolete procedure.

摘要

将小鼠(nu/nu)和大鼠(rnu/rnu)的胸腺发育不全突变体用作21岁患有康恩综合征男性患者的一个醛固酮瘤组织以及28岁患有库欣综合征女性患者的一个腺瘤组织的受体。在这项动物实验研究中,我们成功证明先天性无胸腺啮齿动物是肾上腺皮质组织异种移植的理想受体。通过获取活检移植组织的光镜和电镜照片证明移植物的存活能力,并通过测量血浆肾素、皮质醇以及醛固酮、皮质醇和皮质酮的尿排泄量记录其内分泌功能。介绍了15例接受库欣病手术治疗的患者。14例肾上腺皮质增生患者接受了双侧肾上腺切除术,2例在肾上腺切除术后将肾上腺组织自体移植到前臂肌肉中。1例患者接受了经蝶窦部分垂体切除术。我们在库欣病方面的临床经验表明,初始手术可针对垂体,仅在手术不成功时才针对肾上腺。肾上腺切除术后的肾上腺自体移植是一种过时的手术方法。

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