Korean Journal of Nephrology 1989;8(3):425-444.

한국형 출혈열에서 뇌하수체기능의 의의

김성권 , 한진석 , 이정상

Abstract

Pituitary necrosis is one of the comon findings in the severe to fatal patients with KHF and observed in more than 90% of patients who died in the oliguric phase when the pituitary was examined on autopsy, and thought to be responsible for the clinical pituitary malfunctions. However, the incidence of complicated clinical panhypopituitarism was very low as opposed to frequent findings on autopsy. We studied prospectively 27 KHF patients who admit- ted to Seoul National University Hospital (SNUH) and showed typical clinical courses in order to characterize the changes in the pituitary function and its mor- phological features in KHF and to estimate the occur- rence of panhypopotuitarism during the clinical course by performing the combined pituitary stimulation test (cocktail test) and high resolution sella CT (HRCT) in each patient. 1) The maximal values of TSH after cocktail test increased from the basal value, 2.87±0.47 pU/ml to 9. 17±1.45 pU/ml, that of GH from 3.07±0.43 ng/ml to 16. 32±2.96 ng/ml, and that of cortisol from 14.71±1.61 pg/ dl to 19.94±1.43mg/dl. FSH increased by 2.59±0.42 times and the average from 12.07±3.33 mlU/ml to 27. 27±5.37 mlU/ml, LH by 5.66±0.82 times from 20.16±2. 57 mlU/ml to 74.13±9.09 mlU/ml, and prolactin by 4. 52±0.62 times from 26.04±3.56 ng/ml to 81.09±8.20 ng/ ml. 2) In cases of TSH and GH, there were subnormal rerponses during the oliguric and diuretic phases and normal responses during the convalescent phase. Cor- tisol and FSH failed to show any specific response pattern but the responses of LH and prolactin tended to increase during the oliguric phase and normalize at the diuretic and convalescent phases. It was difficult to characterize the response patterns of the hormones due to the variability in the maximal hormone levels attain- able, the time it took for each hormone to reach the maximal level, and the manifestations in different phases, but in general the responses normalized during the convalescent phase. Specifically, there were statisti- cally significant differencees in the hormonal responses depending on the clnical phase in cases of TSH, GH and LH (p<0.05), whereas there were no such differences in cases of cortisol, FSH and prolactin. 3) In three patients who devleoped panhypopituitar- ism after the acute phase and needed supplementation of the adrenocortical and thyroid hormones, there were no changes of the level of TSH, GH, LH and prolactin with time after stmulation; the levels were significantly lower than those in the disease control group. 4) Among 23 patients on whom HRCT was perfor- med, 6 patients were classified as abnormal on the basis of the presence of severepituitary lesions or the empty sella. In the remaning 17 patients, we observed partial low densities or a decrease in the volume of the pitui- tary gland in 4 patients, and no abnormal changes in 13 patients. These 17 patients were classified as normal. 5) Panhypopituitarism were detected in three patients, all of whom had abnomal sella CT and no response in the cocktail test during the acute phase. A weak response on the cocktail test was seen in three patients with abnormal CT but without c linical pan- hypopituitarism. 17 patients had normal CT findings, 10 with normal cocktail test and seven with abnorma l test. Five of those seven patients also had impaired renal function and two of those had no clinical pan- hypopituitarism. 6) The maximal, poststimulation values of TSH, GH, LH and prolactin were sgnificantly lower in cases with abnomal HRCT findings or impaired renal function than in cases with normal HRCT finclings and renal function. With one-way ANOVA, there were significant differences in TSH, GH, LH and prolactin among the 3 groups (p<0.01). 7) The incidence of panhypopituitarism in KHF was sgnificantly higher than that in patients who admitted to SNUH during the same period; 3 out of 27 v.s. 17 out of 11,686 (p < 0.001). Of the 27 patients, six were abnormal on both HRCT and cocktail test,