Fernández Lucas M, Rivera M, Teruel J L, Ortuño J
Servicio de Nefrología, Hospital Ramón y Cajal, Madrid.
Rev Clin Esp. 1994 Aug;194(8):613-5.
In order to know the prevalence rate of adrenal insufficiency among patients with renal failure due to amyloidosis; we have performed a stimulation test with synthetic corticotropin hormone (Nuvacthen test) in nine patients diagnosed of renal amyloidosis and in five controls. We also measured ACTH and plasma cortisol levels. In two out of nine patients (22%) a low ACTH, low plasmatic cortisol and an abnormal response to Nuvacthen test were detected being diagnosed of primary adrenal insufficiency. We conclude that adrenal insufficiency is not an infrequent finding in systemic amyloidosis and may be due to secondary amyloidotic infiltration of adrenal or pituitary glands. Though Nuvacthen test is a useful test to diagnose subclinical adrenal insufficiency, in our series patients with an abnormal response also had low levels of basal cortisol and ACTH and no one patient with normal basal levels had an abnormal response to the stimulation test.
为了解淀粉样变性所致肾衰竭患者中肾上腺功能不全的患病率；我们对9例诊断为肾淀粉样变性的患者和5例对照者进行了合成促肾上腺皮质激素刺激试验（Nuvacthen试验）。我们还测量了促肾上腺皮质激素（ACTH）和血浆皮质醇水平。9例患者中有2例（22%）检测到促肾上腺皮质激素水平低、血浆皮质醇水平低且对Nuvacthen试验反应异常，被诊断为原发性肾上腺功能不全。我们得出结论，肾上腺功能不全在系统性淀粉样变性中并非罕见发现，可能是由于肾上腺或垂体的继发性淀粉样变性浸润所致。虽然Nuvacthen试验是诊断亚临床肾上腺功能不全的有用试验，但在我们的系列研究中，反应异常的患者基础皮质醇和促肾上腺皮质激素水平也低，且基础水平正常的患者对刺激试验均无异常反应。
