Minamori Y, Yasuda K, Murayama M, Morita H, Yamakita N, Miura K
Third Department of Internal Medicine, Gifu University School of Medicine, Japan.
Endocr J. 1993 Oct;40(5):545-56. doi: 10.1507/endocrj.40.545.
Effects of reserpine treatment, not associated with pituitary irradiation, on the pituitary-adrenocortical axis in a total of 37 untreated patients with Cushing's disease were evaluated. With short-term treatment (2 mg daily for 2 weeks, n = 36), basal excretion of urinary 17-OHCS significantly decreased from 11.2 +/- 5.2 mg/day/m2 (body surface area) (mean +/- SD) to 9.6 +/- 4.4 mg/day/m2 (P < 0.01), and metyrapone-induced incremental responses of urinary 17-OHCS decreased from 58.4 +/- 41.4 mg/3 days/m2 to 45.9 +/- 29.8 mg/3 days/m2 (P < 0.05). Long-term treatment (1.7 +/- 0.3 mg/day for a mean of 15.8 +/- 19.9 weeks) induced a marked reduction in plasma cortisol, and 24-h urinary 17-OHCS and/or free cortisol in 4 of 8 patients examined. Long-term reserpine administration caused normal suppression of plasma cortisol (or 11-OHCS) in 3 of 9 patients with 1 mg, and in all of 5 patients with an 8 mg overnight dexamethasone suppression test. Plasma ACTH response to CRH was evidently decreased in one patient evaluated one month after the initiation of reserpine. The circadian rhythm of plasma cortisol was normal in one patient when the basal glucocorticoid level became normal with reserpine treatment. The present findings suggest that reserpine itself contributes in a causal fashion to the effectiveness of our regimen, reserpine and pituitary irradiation, for some Cushing's disease patients in whom it is effective.
评估了利血平治疗（与垂体照射无关）对37例未经治疗的库欣病患者垂体-肾上腺皮质轴的影响。短期治疗（每日2mg，共2周，n = 36）时，尿17-OHCS基础排泄量从11.2±5.2mg/天/平方米（体表面积）（均值±标准差）显著降至9.6±4.4mg/天/平方米（P<0.01），美替拉酮诱导的尿17-OHCS增量反应从58.4±41.4mg/3天/平方米降至45.9±29.8mg/3天/平方米（P<0.05）。长期治疗（平均15.8±19.9周，每日1.7±0.3mg）使8例受检患者中的4例血浆皮质醇、24小时尿17-OHCS和/或游离皮质醇显著降低。长期给予利血平使9例患者中的3例在1mg剂量时以及5例患者在8mg过夜地塞米松抑制试验中血浆皮质醇（或11-OHCS）得到正常抑制。在开始使用利血平1个月后评估的1例患者中，血浆促肾上腺皮质激素对促肾上腺皮质激素释放激素的反应明显降低。当利血平治疗使基础糖皮质激素水平恢复正常时，1例患者的血浆皮质醇昼夜节律正常。目前的研究结果表明，对于某些使用利血平有效的库欣病患者，利血平本身是我们的治疗方案（利血平和垂体照射）有效的原因之一。
