Yanovski J A, Nieman L K, Doppman J L, Chrousos G P, Wilder R L, Gold P W, Kalogeras K T
Office of the Director, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA.
J Clin Endocrinol Metab. 1998 May;83(5):1485-8. doi: 10.1210/jcem.83.5.4766.
The objective of this study was to determine whether measurements of human CRH in the inferior petrosal sinuses could distinguish patients with Cushing's syndrome from those with pseudo-Cushing states or normal physiology. Twenty-five patients with Cushing's disease, 17 patients with the syndrome of ectopic ACTH, 7 patients with Cushing's syndrome of adrenal origin, 6 patients with pseudo-Cushing states, and 11 volunteers believed to have normal hypothalamic-pituitary-adrenal axes were studied. Basal plasma human CRH and ACTH were measured at two time points in the petrosal sinuses and in a peripheral vein. Most subjects were studied after the administration of intravenous diazepam or midazolam and fentanyl, but because of the known inhibitory effects of such sedation on CRH secretion, 2 normal volunteers and 3 patients with pseudo-Cushing states were studied without sedation. Human CRH levels were near or below the detection limit of the assay in all subjects. Although the normal volunteers and patients with pseudo-Cushing states who were studied without sedation had significantly greater inferior petrosal sinus ACTH levels than those who received sedation, there were no differences in measured human CRH levels for any of the groups. We conclude that inferior petrosal sinus human CRH levels are not easily measured in the inferior petrosal sinuses and cannot be used to determine whether individual patients may have hypersecretion of CRH causing their ACTH secretion.
本研究的目的是确定测量岩下窦中人类促肾上腺皮质激素释放激素（CRH）是否能够区分库欣综合征患者与假性库欣状态患者或生理状态正常者。对25例库欣病患者、17例异位促肾上腺皮质激素（ACTH）综合征患者、7例肾上腺源性库欣综合征患者、6例假性库欣状态患者以及11名被认为下丘脑 - 垂体 - 肾上腺轴正常的志愿者进行了研究。在两个时间点测量岩下窦和外周静脉中的基础血浆人类CRH和ACTH。大多数受试者在静脉注射地西泮或咪达唑仑以及芬太尼后进行研究，但由于已知此类镇静对CRH分泌有抑制作用，对2名正常志愿者和3例假性库欣状态患者未进行镇静研究。所有受试者的人类CRH水平接近或低于检测限。尽管未进行镇静研究的正常志愿者和假性库欣状态患者的岩下窦ACTH水平显著高于接受镇静者，但任何组间测量的人类CRH水平均无差异。我们得出结论，岩下窦中的人类CRH水平不易在岩下窦中测量，并且不能用于确定个体患者是否可能存在导致其ACTH分泌的CRH分泌过多。
