副腎皮質機能に関する臨床的研究主としてACTHに対する血中17-OHCSの反応について

第2報 副腎皮質ステロイド剤を長期間投与した際の副腎皮質予備能について

抄録

In treatment with adrenal glucocorticoids, the side-effect requiring strictest attention is a suppression of adrenocortical function. With the aim of estimating the reserve capacity of the adrenal cortex during prolonged corticoid therapy, ACTH test were performed in 15 patients who had received continuons corticoid therapy (group A) and 6 patients who had received intermittent therapy, giving corticoid only 3-4 days in the week (group B). Besides, in 5 cases who apparently showed secondary adrenocortical hypofunction during continuous corticoid therapy, ACTH-Z 40 I.U. were daily administered on 5-7 consective days to reactivate the decreased function of adrenal cortex.
1) In 9 of the 12 patients who had received long-term continuous corticoid therapy, the plasma 17-OHCS response to the ACTH test was markedly decreased, but remained within normal limits in the other 3, who showed seriously deteriorated general conditions and were suffering from psychic or somatic stress.
2) In 12 cases of group A excepting the 3 cases serious deterioration of general condition, a significant negative correlation of response to ACTH with the duration and total dosis of corticoid administration could be established. That is with lengthening of the administration and the inclease of total dosis, the response was found enfeebled. Within the range of dosage used in this study (not less than 17mg daily in prednisolone equivalent), however, no correlation could be observed between the mean daily dosis and the response to ACTH.
3) In 5 patients of the group A, the suppressed adrenocortical function was reactivated by the administration of ACTH-Z 40 I.U. for 3-5 concecutive days.
4) In 4 of the 6 cases of group B, the response to ACTH showed results within normal limits and in the other 2 cases also the response was little anomaly.