目的:探讨促肾上腺皮质激素释放激素(CRH)试验联合基线硫酸脱氢表雄酮(DHEA-S)对中枢肾上腺功能不全的诊断价值。方法：患者（n=215）需要每日或间歇性氢化可的松替代，在CRH试验和基线DHEA-S后，或没有进行替换，对其峰值皮质醇进行回顾性检查。结果：在CRH试验后皮质醇峰值≥17.5µg/dL的106例患者中，无一例需要更换，所有64名皮质醇峰值<10.0µg/dL的患者都需要每日更换。在10.0µg/dL≤皮质醇峰值<17.5µg/dL且基线DHEA-S低于参考范围的8例患者中，6例患者需要每日更换，1例患者进行间歇性更换。在37名10.0µg/dL≤皮质醇峰值<17.5µg/dL且基线DHEA-S在参考范围内的患者中，10例和6例患者进行间歇性和每日置换，分别。结论：没有皮质醇峰值≥17.5µg/dL的患者需要氢化可的松替代治疗，所有皮质醇峰值低于10.0µg/dL的患者需要每日更换。需要仔细的临床评估，以确定10.0µg/dL≤峰值皮质醇<17.5µg/dL的患者的更换要求，即使与基线DHEA-S结合使用。J.Med.投资。69:287-293,8月,2022年。
Objective : To examine diagnostic performance of corticotropin-releasing hormone (CRH) test combined with baseline dehydroepiandrosterone sulfate (DHEA-S) in patients with a suspect of central adrenal insufficiency. Methods : Patients (n=215) requiring daily or intermittent hydrocortisone replacement, or no replacement were retrospectively checked with their peak cortisol after CRH test and baseline DHEA-S. Results : None of 106 patients with the peak cortisol ≥ 17.5 µg / dL after CRH test required replacement, and all 64 patients with the peak cortisol < 10.0 µg / dL required daily replacement. Among 8 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S below the reference range, 6 patients required daily replacement and 1 patient was under intermittent replacement. Among 37 patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL and baseline DHEA-S within the reference range, 10 and 6 patients were under intermittent and daily replacement, respectively. Conclusions : No patients with the peak cortisol ≥ 17.5 µg / dL required hydrocortisone replacement, and all patients with the peak cortisol below 10.0 µg / dL required daily replacement. Careful clinical evaluation was required to determine requirement for replacement in patients with 10.0 µg / dL ≤ the peak cortisol < 17.5 µg / dL even in combination with baseline DHEA-S. J. Med. Invest. 69 : 287-293, August, 2022.
