Rosman P M, Farag A, Peckham R, Benn R, Tito J, Bacci V, Wallace E Z
J Clin Endocrinol Metab. 1982 Mar;54(3):528-33. doi: 10.1210/jcem-54-3-528.
The response to iv dexamehasone was studied in patients with chronic renal failure in whom resistance to suppression of plasma cortisol levels after oral steroid had been reported previously. One milligram of dexamethasone was given iv at 2300 h, and plasma cortisol levels were measured every 20 min between 0500-1000h in patients with renal failure, normal controls, and patients with pituitary-dependent Cushing's syndrome. Normal subjects showed a decrease in mean plasma cortisol levels to less than 3 micrograms/dl; patients with Cushing's syndrome showed no suppression of cortisol secretory activity during the sampling period. In renal failure patients, morning cortisol levels fell to values lower than those achieved when the 1-mg dose was given orally or when the steroid was not given, but did not suppress to the levels seen in normals. Early resumption of cortisol secretion occurred in four of five renal failure patients during the 6-11 h after dexamethasone administration. These studies show that iv dexamethasone is more effective than the oral steroid in suppressing pituitary-adrenocortical activity in renal failure patients. However, the incomplete suppression and early resumption of cortisol secretion which are present in chronic renal failure patients even after iv dexamethasone support the suggestion that they have disordered feedback control of the hypothalamic-pituitary-adrenocortical axis.
对慢性肾衰竭患者静脉注射地塞米松的反应进行了研究，这些患者此前曾被报道对口服类固醇后血浆皮质醇水平的抑制存在抵抗。在23:00静脉注射1毫克地塞米松，在05:00至10:00期间，对肾衰竭患者、正常对照者和垂体依赖性库欣综合征患者每隔20分钟测量一次血浆皮质醇水平。正常受试者的平均血浆皮质醇水平降至低于3微克/分升；库欣综合征患者在采样期间皮质醇分泌活性未受抑制。在肾衰竭患者中，早晨皮质醇水平降至低于口服1毫克剂量或未给予类固醇时所达到的值，但未抑制至正常水平。在五名肾衰竭患者中，有四名在给予地塞米松后的6至11小时内皮质醇分泌提前恢复。这些研究表明，静脉注射地塞米松在抑制肾衰竭患者垂体 - 肾上腺皮质活性方面比口服类固醇更有效。然而，即使在静脉注射地塞米松后，慢性肾衰竭患者仍存在皮质醇分泌抑制不完全和提前恢复的情况，这支持了他们下丘脑 - 垂体 - 肾上腺皮质轴反馈控制紊乱的观点。
