Impallomeni M, Kaufman B M, Palmer A J
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Postgrad Med J. 1994 Feb;70(820):86-91. doi: 10.1136/pgmj.70.820.86.
Several studies have shown that anterior pituitary function is affected by the ageing process. Little is known, however, about the effect acute diseases have on the anterior pituitary. Should they be associated with a disturbance of anterior pituitary hormone production, they might make anterior pituitary function tests difficult to interpret when they are most needed. To test this hypothesis, we studied the thyrotrophin (TSH) releasing hormone (TRH) test and basal plasma gonadotrophins, taken as indicators of anterior pituitary function and reserve, in 74 consecutive patients (49 women) mean age 82 +/- 5.1 suffering from acute diseases soon after admission to hospital. A total of 44 (30 women) were followed up and retested after 3 disease-free months following recovery and discharge home. Seventy-one age- and sex-matched healthy controls (47 women), mean age 82 +/- 5.0 living in the community were also studied. The mean peak TSH increment after TRH (mean delta max TSH) increased from 5.7 soon after admission, to 7.7 U/l at follow-up (P = 0.01). The mean plasma LH increased from 25 to 35 U/l in women (P = 0.0004) and from 9.7 to 14 U/l in men (P = 0.03). The mean plasma FSH increased from 21 to 25 U/l in women (P = 0.04) and from 7.5 to 9.4 U/l in men (P = 0.01). Controls had greater TSH responses to TRH and higher plasma gonadotrophins levels when compared with acute patients (LH women P = 0.17, for all other tests P < 0.05). We conclude that a transient reduction of anterior pituitary function is a common occurrence in patients over the age of 75 suffering from acute diseases. This has diagnostic relevance and therapeutic implications.
多项研究表明，垂体前叶功能受衰老过程影响。然而，关于急性疾病对垂体前叶的影响却知之甚少。如果它们与垂体前叶激素分泌紊乱有关，那么在最需要的时候可能会使垂体前叶功能测试难以解释。为了验证这一假设，我们对74例连续入院的急性病患者（49名女性）进行了研究，这些患者平均年龄为82±5.1岁，以促甲状腺激素（TSH）释放激素（TRH）试验和基础血浆促性腺激素作为垂体前叶功能和储备的指标。共有44例（30名女性）患者在康复出院并经过3个月无病期后接受了随访和重新测试。还对71名年龄和性别匹配的健康对照者（47名女性）进行了研究，这些对照者平均年龄为82±5.0岁，生活在社区。TRH刺激后TSH的平均峰值增量（平均最大TSH变化量）从入院后不久的5.7增加到随访时的7.7 U/l（P = 0.01）。女性血浆LH的平均值从25 U/l增加到35 U/l（P = 0.0004），男性从9.7 U/l增加到14 U/l（P = 0.03）。女性血浆FSH的平均值从21 U/l增加到25 U/l（P = 0.04），男性从7.5 U/l增加到9.4 U/l（P = 0.01）。与急性病患者相比，对照组对TRH的TSH反应更强，血浆促性腺激素水平更高（女性LH P = 0.17，其他所有测试P < 0.05）。我们得出结论，75岁以上患有急性疾病的患者中，垂体前叶功能短暂减退很常见。这具有诊断意义和治疗意义。
