気管支喘息患者の下垂体副腎機能について
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概要
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The function of the adrenal medulla and of the pituitary-adrenocortical axis has been studied in both asymptonic and symptomatic patients with bronchial asthma. <BR>Markedly increased excretion of adrenalin adn nor-adrenalin are induced by the attack of asthma, while in asymptomatic state noradrenaline alone increased. <BR>In the asymptomatic, baseline excretion of urinary 17-OHCS is normal. Admini-stration of SU-4885 and ACTH-Z shows normal response. Elevation of plasma cortisol after administration of bacterial pyrogen is within normal limits. Moreover, diurnal rhythm of plasma cortisol shows normal pattern. So that the function of pituitary-adrenal axis in these patients are normally maintained. <BR>In the symptomatic, however, baseline of urinary 17-OHCS is lower than that of controls. After administration of 100mg. of cortisol, urinary excretion of 17-OHCS also decreases as compared with the normal. On the other hand, plasma cortisol level is markedly elevated. Although GFR and RPF decreases during an attack of athma, halflife of cortisol in blood is within normal limts, so that removal rates of cortisol is without change. Moreover, it is shown that cortisol secretion rates increase significantly. Thus, the elevation of plasma cortisol is due to a transient hypersecretion from the adrenal in response to the attack of asthma and not due to a retention in plasma. These results demonstrate that the function of the pituitary-adrenal axis in the symptomatic is also normally maintained, and it is suggested that both a temporary impaired reanl function and an altered cortisol metabolism, could well cause a decrease of 17-OHCS excretion despite the elevation of plasma cortisol level. <BR>Although a number of studies were performed in an attempt to elucicdate pituitary-adrenal function in patients with bronchial asthma, conclusions have been contradictory. <BR>The majority of reports confirmed that the urinary excretion of 17-KS and 17-OHCS were low in asthmatic patients when compared with that of the normal, indicating pituitary-adrenal hypofunction. Others demonstrated, however, that excretion of 17-KS and 17-KGS in these patients are within normal limits. On the other hand, Siegel and his associates found that plasms 17-OHCS concentration was high during attacks of asthma, suggestiong normal, or hyperfunction of pituitary-adrenal axis. <BR>These conflicting findings stimulated us to make further extensive studies of pituitary-adrenal activity, along with the function of the adrenal medulla, in asthmatic patients.
- 日本内分泌学会の論文