種々の視床下部下垂体疾患におけるsulpirideの血漿TSHに及ぼす影響
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概要
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It is commonly accepted that hypothalamic dopamine has an inhibitory role not only on prolactin but also on TSH secretion. To study the hypothalamic dopaminergic participation in TSH secretion in various hypothalamo-pituitary disorders, we examined the effect of sulpiride, a dopamine antagonist.<BR>Using a commercially available human TSH radioimmunoassay (RIA) kit and improving it, we developed a high sensitivity RIA for human TSH (assay sensitivity : 0.15μU/ml, 50% B/B<SUB>0</SUB> values : 3.47μU/ml).<BR>In 18 normal controls, plasma TSH increased significantly after intramuscular injection of sulpiride of 1.01±0.17μU/ml (Mean±SEM). In 61 patients with pituitary adenoma, plasma TSH responses to sulpiride were significantly greater than those of normal controls, and the mean maximal increments were as follows : 1.65±0.24μU/ml in acromegaly (n=21), 2.63±0.551μU/ml in non-functioning pituitary adenoma (n=23), and 4.49±0.70μU/ml in prolactin producing pituitary adenoma (n=17), respectively. The maximal TSH responses to sulpiride in prolactin-producing pituitary adenoma were significantly greater than those in non-functioning pituitary adenoma (p<0.05) and those in acromegalic patients (p<0.001). On the other hand, we could observe no TSH responses to sulpiride in 9 cases of hypothalamic tumor with hyperprolactinemia.<BR>These results suggest that the dopaminergic inhibitory influence on TSH secretion is increased in patients with pituitary adenoma, and that it is especially dominant in patients with prolactin producing pituitary adenoma. It is concluded that hypothalamic dopaminergic tone can be evaluated indirectly by the sulpiride test, and that the test is useful in the differential diagnosis of hypothalamo-pituitary disorders.
- 一般社団法人 日本内分泌学会の論文