Barrande G, Thomopoulos P, Luton J P
Clinique des Maladies Endocriniennes et Métaboliques, Hôpital Cochin, Paris.
Ann Endocrinol (Paris). 1998 Apr;59(1):27-30.
It is commonly believed that a normal cortisol response to exogenous ACTH (synacthen test) reliably indicates, with the exception of states of acute ACTH deprivation, the integrity of hypothalamic-pituitary-adrenocortical function. Published evidence has shown that the synacthen test is not sensitive enough to reveal partial ACTH deficiency leading to a subnormal ACTH response to stress. We report a patient who maintained a normal response to exogenous ACTH stimulation despite symptomatic chronic ACTH deficiency in unstressed conditions. A normal cortisol response in the synacthen test does not therefore exclude the possibility of clinically relevant ACTH deficiency.
人们普遍认为，除急性促肾上腺皮质激素（ACTH）缺乏状态外，对外源性ACTH的正常皮质醇反应（辛纳肽试验）可靠地表明下丘脑 - 垂体 - 肾上腺皮质功能的完整性。已发表的证据表明，辛纳肽试验不够敏感，无法揭示导致对应激的ACTH反应低于正常水平的部分ACTH缺乏。我们报告了一名患者，尽管在无应激状态下存在有症状的慢性ACTH缺乏，但对外源性ACTH刺激仍保持正常反应。因此，辛纳肽试验中正常的皮质醇反应并不能排除临床相关ACTH缺乏的可能性。
