Foppiani L, Sessarego P, Valenti S, Falivene M R, Cuttica C M, Giusti Disem M
Cattedra di Endocrinologia, University of Genoa, Italy.
Eur J Clin Invest. 1996 Oct;26(10):879-83. doi: 10.1111/j.1365-2362.1996.tb02133.x.
Both arginine vasopressin (AVP) and corticotropin-releasing hormone (CRH) are involved in the release of ACTH in man. Desmopressin (DDAVP), a synthetic analogue of AVP, has been shown to have a CRH-like action (able to promote ACTH and cortisol release) in animals but not in normal man. Nevertheless, DDAVP is able to release ACTH and cortisol in ACTH-dependent Cushing's disease. We studied eight anorexia nervosa (AN) patients [as AN is a condition in which chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis is commonly reported] in a refeeding phase of the disease, to evaluate whether, after weight gain, ACTH and cortisol response to ovine corticotropin-releasing hormone (oCRH) [1 microgram i.v. DDAVP alone and as pretreatment to oCRH (1 microgram kg-1 BW i.v.)-induced secretion of ACTH and cortisol. We studied six normal women as control subjects. No significant differences in ACTH and cortisol responses to oCRH were found between AN patients and control subjects. DDAVP was not able to stimulate ACTH or cortisol release in AN patients or in control subjects, but in the latter it was able to significantly enhance (P < 0.05) ACTH [area under curve (AUC): 590.0 +/- 104.4 pmol L-1 120 min-1] and cortisol (AUC: 28899.0 +/- 6935.2 nmol L-1 120 min-1) responses to oCRH (ACTH AUC: 325.7 +/- 101.7 pmol L-1 120 min-1, cortisol AUC: 14197.4 +/- 2930.0 nmol L-1 120 min-1). The present data show that DDAVP does not stimulate ACTH and cortisol in AN patients or, as previously reported, in normal subjects. However, DDAVP is able to enhance ACTH and cortisol release after oCRH administration in normal subjects but not in AN patients. This finding could be due to a down-regulation of hypophyseal DDAVP V3 receptors in AN as a direct consequence of the hypercortisolaemic status usually present.
精氨酸加压素（AVP）和促肾上腺皮质激素释放激素（CRH）均参与人类促肾上腺皮质激素（ACTH）的释放。去氨加压素（DDAVP）是AVP的一种合成类似物，在动物实验中已显示具有CRH样作用（能够促进ACTH和皮质醇释放），但在正常人类中并非如此。然而，DDAVP能够在依赖ACTH的库欣病中释放ACTH和皮质醇。我们研究了8例神经性厌食症（AN）患者[由于AN是一种通常报道存在下丘脑 - 垂体 - 肾上腺（HPA）轴慢性激活的疾病]在疾病的重新进食阶段，以评估体重增加后，ACTH和皮质醇对羊促肾上腺皮质激素释放激素（oCRH）[静脉注射1微克]单独以及作为oCRH（静脉注射1微克/千克体重）诱导的ACTH和皮质醇分泌的预处理的反应。我们研究了6名正常女性作为对照受试者。在AN患者和对照受试者之间，未发现对oCRH的ACTH和皮质醇反应有显著差异。DDAVP在AN患者或对照受试者中均不能刺激ACTH或皮质醇释放，但在后者中它能够显著增强（P < 0.05）对oCRH的ACTH[曲线下面积（AUC）：590.0±104.4皮摩尔/升·120分钟-1]和皮质醇（AUC：28899.0±6935.2纳摩尔/升·120分钟-1）反应（ACTH AUC：325.7±101.7皮摩尔/升·120分钟-1，皮质醇AUC：14197.4±2930.0纳摩尔/升·120分钟-1）。目前的数据表明，DDAVP在AN患者中不刺激ACTH和皮质醇，或者如先前报道的那样，在正常受试者中也不刺激。然而，DDAVP能够增强正常受试者在给予oCRH后ACTH和皮质醇的释放，但在AN患者中则不能。这一发现可能是由于通常存在的高皮质醇血症状态直接导致AN患者垂体DDAVP V3受体下调所致。
