NORMAL VALUES FOR A SHORT-TIME ACTH INTRAVENOUS AND INTRAMUSCULAR STIMULATION TEST IN WOMEN IN THE REPRODUCTIVE AGE

被引：9

作者：

GRUNWALD, K

RABE, T

URBANCSEK, J

RUNNEBAUM, B

VECSEI, P

机构：

[1] Division of Gynecological Endocrinology, Department of Obstetrics and Gynecology, University of Heidelberg

[2] Institute of Pharmacology, University of Heidelberg

来源：

GYNECOLOGICAL ENDOCRINOLOGY | 1990年 / 4卷 / 04期

关键词：

D O I：

10.3109/09513599009024983

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Normal values in endocrine testing are the most important precondition for the recognition of disorders of the endocrine system. To establish a reference range for adrenocorticotropic hormone (ACTH) stimulation tests, an intravenous and intramuscular ACTH stimulation test was conducted in 29 female volunteers without hyperandrogenism. A total of 25 IU of ACTH were administered intravenously or intramuscularly and blood sampling was performed before, 1 h and 2 h after ACTH injection. The test was performed on days 3-5 of the menstrual cycle. The following steroid hormones were assessed in the serum: 17alpha-hydroxyprogesterone, 17alpha-hydroxypregnenolone, dehydroepiandrosterone, testosterone, free testosterone and 5alpha-dihydrotestosterone. The normal range was defined by the interval between the 5th and 95th percentiles; additionally the 1st, 25th, 50th, 75th and 99th percentiles are reported. A significant increase of serum hormone levels after ACTH administration could be observed for the following hormones: cortisol, 17alpha-hydroxyprogesterone, 17alpha-hydroxypregnenolone and dehydroepiandrosterone. There was no rise after ACTH application for testosterone, 5alpha-dihydrotestosterone and free testosterone. It could be shown for all hormones that there was no significant difference between the serum levels that were reached after intravenous and intramuscular ACTH injection. Neither could we find a significant difference in the relative increase of the serum hormones when stimulation values were related to basal values. Since in most studies with ACTH stimulation tests, only the serum values 1 h after ACTH application are measured, we investigated whether the measurement of steroid hormones 2 h after ACTH application gave further information. We could demonstrate that for most measured serum hormones the majority of the volunteers had the maximal response 2 h after ACTH application, no matter whether ACTH was injected intramuscularly or intravenously. As a conclusion, we recommend the measurement of the respective hormones not only 1 h but also 2 h after ACTH stimulation. Since there is no increase after ACTH stimulation for total testosterone, free testosterone and 5alpha-dihydrotestosterone, it is sufficient to assess the basal values of these hormones. Excessive adrenal response is reflected by dehydroepiandrosterone, 17alpha-hydroxyprogesterone, 17alpha-hydroxypregnenolone and cortisol.

引用

页码：287 / 306

页数：20

共 16 条

[1]

Pang S., Lerner A.J., Stoner E., Levine L.S., Oberfield S.E., Engel I., New M.I., Late-onset adrenal steroid 3β-hydroxysteroid dehydrogenase deficiency. I. A cause of hirsutism in pubertal and postpubertal women, J. Clin. Endocrinol. Metab, 60, (1985)

[2]

Levine L.S., Dupont B., Lorenzen F., Pang S., Pollack M., Oberfield S., Kohn B., Lerner Cacciari A.E., Mantero F., Cryptic 21-hydroxylase deficiency in families of patients with classical congenital adrenal hyperplasia, J. Clin. Endocrinol. Metab, 51, (1980)

[3]

Lucky A.W., Rosenfield R.L., McGuire J., Rudy S., Helke J., Adrenal androgen hyperresponsiveness to adrenocorticotropin in women with acne and/or hirsutism: adrenal enzyme defects and exaggerated adrenarche, J. Clin. Endocrinol. Metab, 62, (1986)

[4]

Milevicz A., Vecsei P., Korth-Schutz S., Haack D., Rosier A., Lichtwald K., Lewicka S., von Mittelstaed G., Development of plasma 21-desoxycortisol radioimmunoassay and application to the diagnosis of patients with 21 -hydroxylase deficiency, J. Steroid Biochem, 21, (1984)

[5]

Kehlet H., Binder C., Value of the ACTH stimulation test in assessing the hypothalamic-pituitary-adrenal function in glucocorticoid-treated patients, Br. Med. J, 2, (1973)

[6]

Landon J., James V.H.T., Cryer R.J., Wynn V., Frankland A.W., Adrenocorticotropic effects of a synthetic polypeptide - β1-24-corticotropin - in man, J. Clin. Endocrinol. Metab, 24, (1976)

[7]

Rosenfield R.L., Plasma testosterone binding globulin and indexes of the concentration of unbound plasma androgens in normal and hirsute females, J. Clin. Endocrinol, 32, (1971)

[8]

Abraham G.E., Chakmakjian Z.H., Plasma steroids in hirsutism, Obstet. Gynecol, 44, (1974)

[9]

Guthrie P.G., Wilson A., Quillen L., Jawad M.J., Adrenal androgen excess and defective 11-hydroxylation in women with idiopathic hirsutism, Arch. Intern. Med, 142, (1982)

[10]

Mathur R.S., Moody L.O., Landgrebe S., Williamson H.O., Plasma androgens and sex-hormone-binding globulin in the evaluation of hirsute females, Fertil. Steril, 35, (1981)

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