Wallace E Z, Rosman P, Toshav N, Sacerdote A, Balthazar A
J Clin Endocrinol Metab. 1980 Jan;50(1):46-51. doi: 10.1210/jcem-50-1-46.
Pituitary-adrenocortical function was studied in patients with chronic renal failure (CRF) and compared with that in normal subjects. All CRF patients were on chronic hemodialysis. The mean morning plasma total and free (nonprotein bound) cortisol levels were higher in patients with CRF. Episodic secretion of cortisol was studied in plasma sampled every 20 min for 24 h. CRF patients demonstrated normal circadian rhythmicity, as evidence by times of peak secretory activity and number of peaks per 24 h. Mean 24-h plasma total cortixol levels were twice the normal levels in CRF patients. Nine of 10 patients with CRF did not suppress plasma total cortisol levels with 1 mg dexamethasone. Four of 10 patients with CRF suppressed with 2 mg dexamethasone orally for 2 days, 5 patients suppressed after 8 mg dexamethasone administration, and 1 patient with CRF resisted suppression. Hemodialysis did not alter mean 24-h cortisol levels or numbers of secretory episodes but produced a shift of secretory activity into the dialysis time period. These studies show alterations in cortisol dynamics in which increased plasma cortisol levels and dexamethasone resistance coexist with normal circadian rhythmicity.
对慢性肾衰竭（CRF）患者的垂体 - 肾上腺皮质功能进行了研究，并与正常受试者进行了比较。所有CRF患者均接受慢性血液透析治疗。CRF患者早晨血浆总皮质醇和游离（非蛋白结合）皮质醇水平较高。通过每20分钟采集一次血浆样本，持续24小时来研究皮质醇的间歇性分泌。CRF患者表现出正常的昼夜节律，这可通过分泌活动高峰时间和每24小时的高峰次数来证明。CRF患者24小时血浆总皮质醇水平平均为正常水平的两倍。10名CRF患者中有9名使用1毫克地塞米松后血浆总皮质醇水平未被抑制。10名CRF患者中有4名口服2毫克地塞米松2天后被抑制，5名患者在给予8毫克地塞米松后被抑制，1名CRF患者抵抗抑制。血液透析并未改变24小时平均皮质醇水平或分泌发作次数，但使分泌活动转移到透析时间段。这些研究表明皮质醇动力学存在改变，即血浆皮质醇水平升高和地塞米松抵抗与正常昼夜节律并存。
