Hosogi H, Takahara J, Yasuhara T, Hashimoto K, Ofuji T
Nihon Naibunpi Gakkai Zasshi. 1976 Jan 20;52(1):54-61. doi: 10.1507/endocrine1927.52.1_54.
Hypothalamic-pituitary-adrenocortical function was investigated in 14 patients with anorexia nervosa. Impaired suppression of plasma cortisol by dexamethasone was revealed. In 14 patients with anorexia nervosa, circadian rhythm of plasma cortisol, insulin tolerance test, rapid ACTH test and overnight dexamethasone suppression test were examined. Levels of plasma cortisol were higher than those in control subjects throughout the day, and normal circadian rhythm of plasma cortisol was not observed. Basal levels of plasma ACTH were within normal range. tthe response of plasma cortisol to insulin-induced hypoglycemia was lower than that in control subjects, while the response of plasma cortisol in rapid Acth test was normal. In overnight suppression tests, in which one mg dexamethasone was administered orally, 11 of 14 patients showed no suppression of plasma cortisol and 3 other patients showed incomplete suppression. Elevated levels of plasma cortisol and the absence of normal circadian rhythm in patients with anorexia nervosa and malnutrition have already been reported by other investigators, and these abnormalities were ascribed to the delayed half life of plasma cortisol due to impaired cortisol metabolism. However, according to our investigation, it is difficult to explain the failure of dexamethasone to suppress cortisol only by the delayed half life of plasma cortisol, and it is supposed that some kind of abnormal hypothalamic control is also involved.
对14例神经性厌食症患者的下丘脑 - 垂体 - 肾上腺皮质功能进行了研究。结果显示地塞米松对血浆皮质醇的抑制作用受损。对14例神经性厌食症患者进行了血浆皮质醇的昼夜节律、胰岛素耐量试验、快速促肾上腺皮质激素（ACTH）试验和过夜地塞米松抑制试验。患者全天血浆皮质醇水平均高于对照组，且未观察到正常的血浆皮质醇昼夜节律。血浆ACTH基础水平在正常范围内。血浆皮质醇对胰岛素诱导的低血糖的反应低于对照组，而在快速ACTH试验中血浆皮质醇的反应正常。在口服1毫克地塞米松的过夜抑制试验中，14例患者中有11例血浆皮质醇未被抑制，另外3例患者抑制不完全。其他研究者已报道神经性厌食症和营养不良患者血浆皮质醇水平升高且无正常昼夜节律，这些异常归因于皮质醇代谢受损导致血浆皮质醇半衰期延长。然而，根据我们的研究，仅通过血浆皮质醇半衰期延长很难解释地塞米松不能抑制皮质醇的现象，推测可能还涉及某种下丘脑控制异常。
