Uticaj luteinizirajućeg hormona na sekreciju steroida kore nadbubrega kod osoba sa slučajno otkrivenim tumorima nadbubrega

Abstract

prevalenciju insulinske rezistencije (IR) kao i to da je nivo IR u direktnoj vezi sa veličinom adrenalnog tumora. Osim toga, sekretorni tumori nadbubrega osetljivi na LH su literaturno dobro dokumentovani. Cilj ove studije bio je da ispita uticaj LH na sekreciju steroida kore nadbubrega. U tom smislu ispitali smo povezanost nivoa LH sa steroidima kore nadbubrega – kortizolom, aldosteronom i dehidroepiandrosteron sulfatom (DHEAS); povezanost LH sa parametrima osovine hipotalamus-hipofiza-nadbubreg; povezanost LH sa kortizolom nakon prekonoćnog deksametazonskog skrining testa (1mg DST). Takođe, želeli smo da ispitamo i povezanost LH i veličine tumora sa IR, kao i odgovor kortizola nakon intramuskularne primene humanog horionskog gonadotropina (hCG). Ova opservaciona, slučaj – kontrola studija sprovedena je u Klinici za endokrinologiju, dijabetes i bolesti metabolizma, Kliničkog centra Srbije. Ukupnu grupu ispitanica činilo je 106 žena u menopauzi: 75 bolesnica sa AI [27 sa nefunkcijskim AI (NAI) i 48 sa (mogućom) autonomnom sekrecijom kortizola ((M)ASK)] i 31 žena kao zdrava kontrola (ZK) uparena prema starosti, indeksu telesne mase, LH i trajanju menopauze. Za procenu IR koristili smo homeostatski model (HOMA-IR), a kod 14 bolesnica je jutro nakon 1mg DST-a i intramuskularne administracije 10.000i.j. hCG-a određivan kortizol na pola sata počevši od 08h zaključno sa 180. minutom. Postojala je pozitivna značajna korelacija između LH i HOMA-IR u celoj AI grupi (r=0.230; p=0.047) i u podgrupi sa (M)ASK (r=0.353; p=0.017), ali ne i u podgrupi sa NAI (r=-0.097, p=0.623). Povezanost veličine tumora sa HOMA-IR bila je značajna u celoj AI grupi (r=0.341; p=0.003) kao i u obe podgrupe: NAI (p=0.018, r=0.445) i (M)ASK (p=0.012, r=0.362). Nakon prilagođavanja prema godinama, ITM i veličini tumora i LH i HOMA-IR su bili značajni prediktori HOMAIR (r2=0.196, p=0.004). Nije bilo značajne povezanosti između LH i HOMA-IR kod žena u zdravoj kontroli. Postojala je pozitivna korelacija između LH i 1mg DST kortizola u celoj AI grupi (r=0.196; p=0.092), koja je bila značajna kod bolesnika sa (M)ASK (r=0.342; p=0.019), ali ne i u podgrupi sa NAI (r=0.151; p=0.444). Postojala je značajna pozitivna korelacija između veličine tumora i 1mg DST kortizola u celoj AI grupi (r=0.568; p<0.001) i u podgrupi sa (M)ASK (r=0.439, p=0.002), ali ne i u podgrupi sa NAI (r=-0.076, p=0.706)...

steroidogenesis in patients with AI. To do so we investigated the associations between LH and adrenal cortex steroids – cortisol, aldosterone and dehydroepiandrosterone sulphate (DHEAS); the association of LH and parameters of hypothalamuspituitary- adrenal axes; the association of LH and cortisol after the 1 mg overnight dexamethasone test (1 mg DST). We also investigated an association between LH and adrenal tumour size (ATS) with IR. This was a case-control study conducted in the Clinic for Endocrinology, Diabetes and Metabolic Diseases in Belgrade, Serbia. The total study group consisted of 106 menopausal women: 75 AI patients [27 with non-functional AI (NAI) and 48 with (possible) autonomous cortisol secretion ((P)ACS)] and 31 age-, BMI-, LHand menopause duration-matched healthy control (HC) women. To estimate IR, we used homeostasis model assessment (HOMA-IR). The morning after 1mg DST 14 patients received 10.000 IU hCG intramuscularly starting at 08.00AM with cortisol measurements every 30 minutes for 3 hours. There was a significant positive correlation between LH and HOMA-IR in the whole AI group (r=0.230; p=0.047) and in patients with (P)ACS (r=0.353; p=0.017), but not in patients with NAI (r=-0.097, p=0.623). The correlation of ATS and HOMA-IR was significant in the whole AI group (r=0.341; p=0.003) and in both NAI (p=0.018, r=0.445) and (P)ACS (p=0.012, r=0.362). After adjusting for age and BMI, both LH and ATS proved to be significant predictors of HOMA-IR, (r2=0.196, p=0.004). There was no significant correlation between LH and HOMAIR in HC. There was a positive correlation between LH and 1 mg-DST cortisol in the whole AI group (r=0.196; p=0.092), which was significant in patients with (P)ACS (r=0.342; p=0.019), but not in patients with NAI (r=0.151; p=0.444). There was a significant positive correlation between ATS and 1 mg-DST cortisol in the whole AI group (r=0.568; p<0.001) and in the (P)ACS subgroup (r=0.439, p=0.002), but not in patients with NAI (r=-0.076, p=0.706). There was no significant correlation between levels of LH and aldosterone or DHEAS. Out of 14 patients, 11 patients showed response to hCG with cortisol secretion, 5 with NAI and 6 with (P)ACS. Maximal cortisol response in group with NAI was 74%, and in group with (P)ACS was 186% compared to cortisol value after 1mg DST...