Murialdo G, Galimberti C A, Fonzi S, Manni R, Costelli P, Parodi C, Torre F, Solinas G P, Polleri A, Tartara A
Department of Endocrinological and Metabolic Sciences, University of Genoa, Italy.
Neuropsychobiology. 1994;30(1):29-36. doi: 10.1159/000119132.
Sex steroid peripheral pattern, pulsatile luteinizing hormone (LH) secretion, gonadotropin and prolactin responses to LH-releasing hormone (LHRH) and thyrotropin-releasing hormone (TRH) were studied in 35 male epileptics treated with phenobarbital (PB), carbamazepine (CBZ), or phenytoin (PHT), and in age-matched healthy males. Idiopathic generalized epilepsy (IGE) was diagnosed in 12 cases and partial epilepsy (PE) in 23 cases. Patients were seizure-free and did not show EEG abnormalities at repeated controls in the last 5 years, so that interfering effects of seizures were possibly excluded. The aim of the study was to evaluate both the role of epileptic syndromes and of anti-epileptic drugs on the endocrine function. Changes in sex hormone binding globulin, total and free testosterone, dihydrotestosterone and delta 4-androstenedione were found to be independent of the epileptic syndrome type. The LH response to LHRH was lower in PB-treated PE than in IGE subjects on the same drug regimen. An impairment of LH pulsatility with respect to controls was found in PE but not in IGE patients taking PB. Among antiepileptic drugs, PHT is associated with higher sex hormone binding globulin and estradiol and lower free testosterone and dihydrotestosterone levels. PB and CBZ, but not PHT, blunt the LH response to exogenous LHRH in PE. Prolactin responses to TRH were consistently enhanced in PE subjects treated with CBZ or PHT.
对35例接受苯巴比妥（PB）、卡马西平（CBZ）或苯妥英（PHT）治疗的男性癫痫患者以及年龄匹配的健康男性，研究了性类固醇外周模式、促黄体生成素（LH）的脉冲式分泌、促性腺激素和催乳素对促黄体生成素释放激素（LHRH）及促甲状腺激素释放激素（TRH）的反应。其中12例诊断为特发性全身性癫痫（IGE），23例为部分性癫痫（PE）。患者在过去5年的多次复查中无癫痫发作且脑电图无异常，从而可能排除了癫痫发作的干扰作用。本研究的目的是评估癫痫综合征和抗癫痫药物对内分泌功能的作用。发现性激素结合球蛋白、总睾酮和游离睾酮、双氢睾酮及δ4-雄烯二酮的变化与癫痫综合征类型无关。在相同药物治疗方案下，PB治疗的PE患者对LHRH的LH反应低于IGE患者。服用PB的PE患者与对照组相比，LH脉冲性有损害，但IGE患者未出现。在抗癫痫药物中，PHT与较高的性激素结合球蛋白和雌二醇水平以及较低的游离睾酮和双氢睾酮水平相关。PB和CBZ可减弱PE患者对外源性LHRH的LH反应，但PHT无此作用。接受CBZ或PHT治疗的PE患者对TRH的催乳素反应持续增强。
