著者

森 頴太郎 荘野 忠泰 井原 元 岩崎 徹 平林 俊明 依藤 良一 宮本 孝 稲垣 王子 井上 聖士 藤田 嘉一

出版者

社団法人 日本腎臓学会

雑誌

日本腎臓学会誌 (ISSN:03852385)

巻号頁・発行日

vol.26, no.6, pp.721-731, 1984 (Released:2010-07-05)

参考文献数

25

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The ACTH-Cortisol axis was studied in chronic renal failure (12 undialysed patients, Ccr below 5 ml/min and 17 dialysed patients). Basal plasma cortisol and ACTH levels were 14.7±1.2μg/dl, 41.4±11.6 pg/ml respectively in undialysed patients and 14.3±1.3μg/dl, 48.6±7.5 pg/ml respectively in dialysed patients. Both hormone levels were within normal range except 1 dialysed patient. The cortisol levels to rapid ACTH stimulation test (250μg ACTH, iv) in both groups increased approximately 10 μg/dl or more. Therefore, we suggest that the patients with chronic renal failure have normal function of adrenal cortex. After the administration of 1 mg dexamethasone orally at midnight as the method of examining negative feedback mechanism, both patients had normal or almost normal suppression of cortisol and ACTH level. But, quarter of patients in each group demonstrated abnormal diurnal rhythm of plasma cortisol and ACTH at 900 hour, 1700 hour. Dialysed patients showed normal cortisol response (Max. ΔCortisol 12.8±1.6μg. dl) to insulin (0.1 U/kg, iv) induced hypoglycemia as a stress test compared with normal controls (Max. ΔCortisol 9.0±0.8 μg/dl). While, undialysed patients showed low cortisol response (Max. ΔCortisol 5.9±1.7μg/dl). And there were no correlation between the Max. ΔCortisol and T. P., BUN, CRN, Uric Acid, Ca and the grade of hypoglycemia. Therefore, it is certain that the failure of secretion of corticotropin releasing factor in hypothalamus or of ACTH secretion in pituitary gland exists in undialysed patients. From these results that there may be impairment of CNS-Hypothalamo-Pituitary Axis in chronic renal failure and this disturbance can be recovered considerably but not perfectly by adequate long term hemodialysis, it was considered that some uremic toxin or dialysable substance associated with uremia itself may be responsible for its abnormality of cortisol and ACTH secretion.