López-Guzmán A, Salvador J, Frutos R, Díez J J, Iglesias P, Sastre J, G-omez-Pan A
Department of Endocrinology, Hospital La Paz, Madrid, Spain.
Clin Endocrinol (Oxf). 1996 Mar;44(3):335-9. doi: 10.1046/j.1365-2265.1996.678499.x.
Several reports have shown an increase in serum gastrin levels in patients with Cushing's syndrome (CS). However, the actual origin of this hypergastrinaemia is not known. Two hypotheses have been proposed: concomitant ACTH and gastrin secretion by corticotrophic pituitary adenomas or hypergastrinaemia induced by hypercortisolism.
We performed simultaneous, bilateral inferior petrosal sinus (IPS) sampling in nine patients with Cushing's disease (CD), proven by histological studies. In all of them, blood samples were taken from both IPS and a peripheral vein to measure plasma ACTH and serum gastrin. In addition, we measured peripheral serum gastrin levels after an overnight fast in 10 patients with CS (seven with pituitary tumours and three with adrenal tumours) before and after surgical treatment.
Petrosal-peripheral and interpetrosal gradients of ACTH were higher than 2.0 and 1.4, respectively, confirming the pituitary origin of ACTH. Mean serum gastrin levels were 149.1 +/- 53.6 ng/l in peripheral vein, 183.4 +/- 71.7 ng/l in dominant IPS and 181.4 +/- 68.9 ng/l in non-dominant IPS. No significant differences in gastrin concentrations in these locations were found. Mean preoperative gastrin level in patients with CD was 194.6 +/- 47.9 ng/l, whereas in patients with adrenal tumours it was 247.3 +/- 125.9 ng/l. After surgical treatment, the gastrin levels decreased to 62.1 +/- 13.2 ng/l (P < 0.05) and 90.3 +/- 50.3 ng/l (NS), respectively.
These results suggest that hypergastrinaemia is a common finding in patients with Cushing's syndrome. The lack of significant petrosal-peripheral gradient in individuals with Cushing's disease and the reduction in gastrin level following adrenal tumour resection argues against the hypothesis of a predominantly pituitary source of gastrin, suggesting a glucocorticoid related mechanism as an explanation for the hypergastrinaemia.
多项报告显示库欣综合征（CS）患者血清胃泌素水平升高。然而，这种高胃泌素血症的实际起源尚不清楚。已提出两种假说：促肾上腺皮质激素垂体腺瘤同时分泌促肾上腺皮质激素（ACTH）和胃泌素，或高皮质醇血症诱导高胃泌素血症。
我们对9例经组织学研究证实为库欣病（CD）的患者进行了同步双侧岩下窦（IPS）采血。对所有患者，从双侧IPS和外周静脉采集血样以测定血浆ACTH和血清胃泌素。此外，我们在手术治疗前后分别测量了10例CS患者（7例垂体肿瘤患者和3例肾上腺肿瘤患者）过夜禁食后的外周血清胃泌素水平。
ACTH的岩下窦-外周梯度和岩下窦间梯度分别高于2.0和1.4，证实了ACTH的垂体起源。外周静脉平均血清胃泌素水平为149.1±53.6 ng/l，优势侧IPS为183.4±71.7 ng/l，非优势侧IPS为181.4±68.9 ng/l。这些部位的胃泌素浓度未发现显著差异。CD患者术前平均胃泌素水平为194.6±47.9 ng/l，而肾上腺肿瘤患者为247.3±125.9 ng/l。手术治疗后，胃泌素水平分别降至62.1±13.2 ng/l（P<0.05）和90.3±50.3 ng/l（无统计学意义）。
这些结果表明高胃泌素血症在库欣综合征患者中很常见。库欣病患者缺乏显著的岩下窦-外周梯度以及肾上腺肿瘤切除后胃泌素水平降低，这与胃泌素主要来源于垂体的假说相悖，提示糖皮质激素相关机制可解释高胃泌素血症。
