正常小児および下垂体性小人症における血中dehydroepiandrosterone sulfateに関する研究

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Adrenal androgen is thought to take part in the expression of secondary sexual characteristics and growth spurt with the onset of puberty. Its secretion is known to rise prior to the increase of gonadotropin and gestagen secretion in the pubertal period. But there are many unsolved problems concerning its physiological activity and the regulation of its secretion. To investigate these problems, we measured serum dehydroepiandrosterone sulfate (DHEA-S) in normal children and 41 patients with pituitary dwarfism and analyzed the relation of serum DHEA-S levels to puberty, growth and pituitary function.<BR>Serum DHEA-S was measured by RIA modified by Buster's method. Serum DHEA-S levels of normal children started to rise after 6 years of age, and rapidly increased over 9 years. Serum DHEA-S levels were well correlated with urinary 17-KS excretion (r=0.85) and increased by ACTH stimulation (basal 54.4 ± 36.8 μg/dl, 4 hrs after ACTH-Z i.m. 86.2 ± 59.4 μg/dl in children over 9 years).<BR>Serum DHEA-S levels in 18 out of 26 cases of pituitary dwarfism over 9 years were definitely below normal. 5 cases who had normal ACTH, prolactin and gonadotropin secretion showed pubertal change and a rapid increase in serum DHEA-S levels during two and a half years of hGH treatment. 2 cases who had normal ACTH and prolactin secretion but were gonadotropin deficient showed a remarkable increase in serum DHEA-S levels without pubertal change. 13 cases with ACTH deficiency showed low levels of serum DHEA-S and no pubertal change with the exception of 1 case. 6 cases with prolactin deficiency and normal ACTH secretion also showed low serum DHEA-S levels. DHEA-S secretion seems to be related to GH, ACTH and prolactin.<BR>During hGH-only treatment and treatment with hGH plus low doses of anabolic steroid (Stanozolol), changes in growth rate were compared among 3 cases with normal serum DHEA-S levels and 10 cases with low serum DHEA-S levels over 9 years. The growth rate of the low DHEA-S group exhibited a waning effect during hGH-only therapy and returned to the optimal growth rate with hGH plus a low dose Stanozolol. The normal DHEA-S group showed a good response to the hGH-only therapy and no remarkable change during the two types of treatment.<BR>These observations suggest that adrenal androgen deficiency exists in many cases of pituitary dwarfism and that supplemental therapy may be needed for hGH to exert its full effect. Serum DHEA-S can be an index of adrenal androgen secretion.
日本内分泌学会の論文

正常小児および下垂体性小人症における血中dehydroepiandrosterone sulfateに関する研究

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