Mitchell D H, Owens B
Division of Medical Oncology, University of Colorado Health Sciences Center, Denver 80262, USA.
J Neurosci Nurs. 1996 Jun;28(3):140-52; quiz 152-4. doi: 10.1097/01376517-199606000-00002.
Replacement therapy is routinely used to treat hormone deficiencies of patients who have had surgery or radiation therapy that damages the hypothalamus or pituitary gland. Hormones commonly replaced include: arginine vasopressin (AVP), growth hormone (GH), cortisol, thyroxine (T4), testosterone and estrogen. AVP, synthesized in the hypothalamus, is stored in and released by the posterior lobe of the pituitary gland. GH is synthesized and released by the anterior pituitary gland. The other hormones are produced and released by target glands each of which is stimulated by a specific anterior pituitary hormone, which in turn is controlled by release of a specific hypothalamic hormone. Feedback control by a high circulating concentration of the target gland's hormone regulates hypothalamic hormone release. Deficiency of AVP, important for water balance in the body, is restored with the synthetic analogue, 1-desamino-8-D-arginine vasopressin (DDAVP); it is given as a nasal spray or by injection. GH is required for normal growth in the developing child; recombinant GH, produced in bacteria, is injected subcutaneously. Adrenocorticotropic hormone (ACTH) controls release of cortisol which is produced by the adrenal cortex and enables the body to cope with stress; cortisol is replaced with prednisolone given orally. Thyroid stimulating hormone (TSH) controls release of the thyroid hormones, T4 and triiodothyronine (T3), which promote growth and development, and regulate energy metabolism; for replacement of T4, oral synthetic L-thyroxine is given. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control release of testosterone, which promotes maturation of sperm and development of male sexual characteristics; replacement testosterone is administered intramuscularly. In females, FSH and LH control release of estrogens and progesterone which prepare the reproductive tract for release of the ovum, fertilization, implantation and development of the embryo, replacement by estrogen and progesterone preparations which are orally effective is given in a cyclic manner. A transdermal delivery system is available. Nursing implications include cautions and contraindications, potential problems of over-replacement, drug interactions as well as patient teaching points.
替代疗法通常用于治疗因手术或放疗损伤下丘脑或垂体而导致激素缺乏的患者。常用替代的激素包括：精氨酸加压素（AVP）、生长激素（GH）、皮质醇、甲状腺素（T4）、睾酮和雌激素。AVP在下丘脑合成，储存于垂体后叶并由其释放。GH由垂体前叶合成并释放。其他激素由靶腺产生和释放，每个靶腺都由一种特定的垂体前叶激素刺激，而该垂体前叶激素又受一种特定下丘脑激素的释放控制。靶腺激素的高循环浓度通过反馈控制来调节下丘脑激素的释放。对维持身体水平衡至关重要的AVP缺乏，可通过合成类似物1-去氨基-8-D-精氨酸加压素（DDAVP）来补充；以鼻喷雾剂或注射方式给药。生长激素对儿童的正常生长至关重要；细菌生产的重组生长激素通过皮下注射给药。促肾上腺皮质激素（ACTH）控制肾上腺皮质产生的皮质醇的释放，使身体能够应对压力；皮质醇用口服的泼尼松龙替代。促甲状腺激素（TSH）控制甲状腺激素T4和三碘甲状腺原氨酸（T3）的释放，这两种激素促进生长发育并调节能量代谢；补充T4时，给予口服合成L-甲状腺素。促卵泡激素（FSH）和黄体生成素（LH）控制睾酮的释放，睾酮促进精子成熟和男性性征发育；替代睾酮通过肌肉注射给药。在女性中，FSH和LH控制雌激素和孕激素的释放，这些激素为卵子释放、受精、着床和胚胎发育准备生殖道，通过口服有效的雌激素和孕激素制剂进行周期性替代给药。有一种透皮给药系统。护理注意事项包括注意事项和禁忌证、替代过量的潜在问题、药物相互作用以及患者教育要点。
