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Hermus医生等对CRH试验和大剂量地塞米松试验做了比较,并强调在解释CRH试验时应慎重。因为要达到对库兴氏综合征病因的准确诊断仍有很大困难。 目前诊断肾上腺皮质瘤困难不大,因为通过在高度质醇血症时测不到血浆基础ACTH以及CT检查可证实。采取综合实验,包括这种新的CRH试验并非必要。当前在库兴氏综合征中的诊断困难在于区别垂体ACTH依赖性库兴氏病与细小隐袭而异位分泌ACTH的相对良性的非垂体性肿瘤。作者的一组病人中ACTH依赖性患者占14％,通常表现出典型的类库兴氏病特征。隐袭性肿瘤患者,其基础生物化学包括血浆ACTH,与垂体性库兴氏病部分重叠,因此动态的生化试验是很必要的。任何一个新的试验如CRH试验都必须建立它本身的指标。
Dr. Hermus et al. compared the CRH test with the high-dose dexamethasone test and emphasized that care should be taken when interpreting the CRH test. Because it is still very difficult to achieve an accurate diagnosis of the cause of Cushing’s syndrome. Current diagnosis of adrenocortical neoplasia is not very difficult because it can be confirmed by plasma-based ACTH and CT scans that are not detectable during hyperalbuminemia. It is not necessary to adopt a comprehensive experiment including this new CRH test. The current difficulty in the diagnosis of Cushing’s syndrome lies in the relatively benign non-pituitary tumors that distinguish pituitary ACTH-dependent Cushing’s disease from small insidious attacks and ectopically secrete ACTH. In the author’s group of patients ACTH-dependent patients accounted for 14%, and typically exhibited typical Cushings disease characteristics. In patients with invasive tumors, their basic biochemistry, including plasma ACTH, partially overlaps with pituitary Cushing’s disease, so dynamic biochemical tests are necessary. Any new experiment such as CRH test must establish its own index.