糖尿病における下垂体副腎機能について
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概要
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In 65 diabetic patients and 15 control subjects, the amounts of urinary total 17-OHCS excretion and it's components were studied in the basal condition and during and after the loading with ACTH, metopiron and dexamethasone. The separation of the individual component was carried out with Kieselguhr partition column chromatography of Tait et al., in which the solvent system was toluene-ethylacetate 12 : 1 v/v : methanol-water 1 : 1 v/v, and the column contained celite 545. This procedure gave the discrete separation of THS, E, F, THE and THF available for routine quantitative analysis.<BR>The amounts of components of 17-OHCS excreted in urine in control subjects were found to be as follows : <BR>THS ; ?-0.05 mg/day (?-2.0%), E ; 0.05-0.1 (2.0-3.6), F ; 0.05-0.1 (1.4-4.0), THE ; 1.3-2.1 (60.0-76.5) and THF ; 0.3-1.2 (17.6-34.6).<BR>In diabetic patients, except for the cases as specified below, a negligible difference was found in urinary 17-OHCS excretion in response to loading as well as in basal condition.<BR>In the cases of mild diabetic retinopathy or nephropathy, however, the following was revealed : (1) slight to moderate increase in the amounts of urinary total 17-OHCS, (2) a slight decrease in 'THE (59.0%) and a slight increase in THF (33.6%) in basal condition, which was similar to the findings observed in control subjects after ACTH loading, (3) greater effects of ACTH on urinary 17-OHCS excretion than in control or other diabetic subjects, (4) considerable suppression of the excretion by dexamethasone, (5) almost normal effects of metopiron and (6) quicker restoration of urinary total 17-OHCS values, after stopping the consecutive loading of metopiron, than in control and other diabetic subjects.<BR>In the cases of Kimmelstiel-Wilson syndrome, the following findings were obtained : <BR>(1) The low values of urinary total 17-OHCS is basal condition, (2) a slight response of total 17-OHCS to either ACTH or metopiron, (3) marked inhibitory effects of metopiron on 118-hydoroxylation in comparison to those in control subjects.<BR>These results support the hypothesis that in the patients with mild diabetic retino-pathy or nephropathy, there must be the disturbance in the feed-back mechanism and the abnormality in the hypothalamus owing to the metabolic stress.
- 日本内分泌学会の論文