Sastre J, Díez J J, López Guzmán A, Iglesias P, Martínez I, Gómez-Pan A
Servicio de Endocrinología y Nutrición, Hospital La Paz, Madrid.
An Med Interna. 1994 Apr;11(4):181-4.
We studied a 55-year-old woman with remarkable cushingoid features, which presented biochemical evidence of suppression of the hypothalamus-hypophysis-adrenal axis. In the detailed anamnesis, we discovered that the patient had used during more than two years a nasal spray containing dexamethasone. In the initial assessment of the suprarenal function, in addition to suppressed concentrations of cortisol and ACTH, we observed the absence of response to acute stimulus (insulinic hypoglycemia and short ACTH test), as well as a normal response to sustained ACTH stimulus. After discontinuing the intranasal administration of dexamethasone, the patient remained asymptomatic; the basal concentrations of ACTH and cortisol, as well as the levels of urinary free cortisol, were normal at 3 months and the responses of cortisol and ACTH to their stimulus were restored to normal levels at 6 months. We conclude that in the cases of Cushing's syndrome with suppression of the hypothalamus-hypophysis-adrenal axis, it is necessary to conduct a detailed investigation on the consumption of glucocorticoids through unusual ways. The presence of a normal response to the sustained stimulus with ACTH may be a quick recovery index of the suprarenal function.
我们研究了一名55岁女性，她具有明显的库欣样特征，生化检查显示下丘脑 - 垂体 - 肾上腺轴受抑制。在详细的病史询问中，我们发现该患者使用含地塞米松的鼻喷雾剂超过两年。在肾上腺功能的初始评估中，除了皮质醇和促肾上腺皮质激素（ACTH）浓度受抑制外，我们还观察到对急性刺激（胰岛素低血糖和短程ACTH试验）无反应，以及对持续ACTH刺激有正常反应。停用鼻内地塞米松后，患者仍无症状；3个月时ACTH和皮质醇的基础浓度以及尿游离皮质醇水平正常，6个月时皮质醇和ACTH对刺激的反应恢复到正常水平。我们得出结论，在下丘脑 - 垂体 - 肾上腺轴受抑制的库欣综合征病例中，有必要对通过非寻常途径使用糖皮质激素的情况进行详细调查。对持续ACTH刺激有正常反应可能是肾上腺功能快速恢复的指标。
