Dolińska-Laskoś C, Grzeszczak W, Zukowska-Szczechowska E
Oddział-Nefrologiczny Wojewódzkiego Szpitala Zespolonego w Kielcach.
Pol Arch Med Wewn. 1993 Apr;89(4):275-85.
Chronic renal failure is often associated with the pituitary-adrenal axis disturbances. In this paper the influence of long term dialysis therapy on the pituitary-adrenal axis functions was investigated. The examinations were carried out in 12 non-dialysed patients compared with 12 patients dialysed 1-50 months, 12 patients dialysed 51-100 months, 12 dialysed longer than 100 months and 12 healthy subjects as a control. In all the serum glucose, ACTH and cortisol levels just before and after hypoglycaemia induced by intravenous insulin administration (0.1 j./kg body weight) were determined. The following results were obtained. 1. In subjects with chronic renal failure the basic ACTH and cortisol levels (a part from patients dialysed longer than 100 months) were significantly increased than in controls. 2. There were no significant differences in ACTH levels in non-dialysed and dialysed shorter than 100 months subjects. 3. The basic cortisol levels were significantly lower in patients dialysed longer than 50 months in non-dialysed or dialysed shorter. 4. The increase of ACTH serum levels caused by hypoglycaemia induced by intravenous insulin was more marked in patients dialysed 50-100 months, than in others. 5. There were no significant differences in mean changes cortisol after insulin induced hypoglycaemia in all groups with chronic renal failure but was lower than in healthy subjects. Conclusions. The long term dialysis seems to influence the pituitary-adrenal axis function in patients with chronic renal failure.
慢性肾衰竭常伴有垂体 - 肾上腺轴功能紊乱。本文研究了长期透析治疗对垂体 - 肾上腺轴功能的影响。对12例未透析患者、12例透析1 - 50个月的患者、12例透析51 - 100个月的患者、12例透析超过100个月的患者以及12名健康受试者作为对照进行了检查。测定了所有受试者静脉注射胰岛素（0.1 j./kg体重）诱发低血糖前后的血清葡萄糖、促肾上腺皮质激素（ACTH）和皮质醇水平。得到以下结果：1. 在慢性肾衰竭患者中（透析超过100个月的患者除外），基础ACTH和皮质醇水平显著高于对照组。2. 未透析和透析时间短于100个月的受试者的ACTH水平无显著差异。3. 透析超过50个月的未透析或透析时间较短的患者的基础皮质醇水平显著较低。4. 静脉注射胰岛素诱发低血糖导致的ACTH血清水平升高在透析50 - 100个月的患者中比其他患者更明显。5. 在所有慢性肾衰竭组中，胰岛素诱发低血糖后皮质醇的平均变化无显著差异，但低于健康受试者。结论：长期透析似乎会影响慢性肾衰竭患者的垂体 - 肾上腺轴功能。
