下垂体腺腫摘除術前後において特異的・非特異的免疫能を検討しえたクッシング病の一例 Changes of Specific and Non-specific Immunological Functions Before and After Transsphenoidal Tumor Excision-A Case of Cushing Disease
The interrelationship between the hypothalamic-pituitary-adrenal axis and the immune system has been becoming clear. However, most research about this interrelationship has been porformed by <I>in vitro</I> experiments and by using animal models. To know the effect of hypercortisolism on human immune systems <I>in vivo</I>, we report at 32-year-old man with typical Cushing disease whose specific and non-specific immunological functions were estimated before and after successful transsphenoidal surgery. We made a diagnosis of Cushing disease with dexamenthasone suppression test, CRF stimulation test, venous sampling, and MRI scan. Before transsphenoidal surgery, both plasma ACTH (100pg/ml) and urinary free cortisol (567μg/day) were higher than the normal range, and the parameters of specific (CD4/CD8 ratio, serum Ig A, PHA/Con-A induced T cell blast formation, and NK cell activity) and non-specific (neutrophil phagocytosis and bactericidal function) immunological functions were clearly impaired. However, at 6 weeks and 6 months after the tumor excision when hormonal abnormalities were changed to normal, every impaired immunological function was improved to the normal range. These data suggest that impaired specific and non-specific immunological functions were induced by hyercortisolism not only <I>in vitro</I> but also <I>in vivo</I> (a state of Cushing disease).
日本内分泌学会雑誌 71(5), 673-678, 1995-05-01