Combined Test for Assessment of Anterior Pituitary Function

Harsoulis, P.; Marshall, John C.; Kuku, S. F.; Burke, C. W.; London, David; Fraser, T. Russell

doi:10.1136/bmj.4.5888.326

Cited by 93 publications

(18 citation statements)

References 17 publications

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“…Although there have been many descriptions of individual abnormalities of the HPA system in man (54,62,92,93), few systematic studies of all 3 types of HPA function have been reported in human subjects. We describe here the results of such studies in 158 patients in whom disorders of the HPA system were suspected because of known pituitary tumors or clinical evidence suggesting functional HPA abnormalities.…”

Section: Authors' Studiesmentioning

confidence: 96%

Normal and Abnormal Function of the Hypothalamic Pituitary-Adrenocortical System in Man*

et al. 1984

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The first half of this manuscript is devoted to a review of the methods used and the results obtained in the published measurements of the normal responses to tests of the three main types of hypothalamic-pituitary-adrenocortical (HPA) activity in man. These are, I, basal, unstressed activity leading to appropriate levels of total daily production of cortisol in the characteristic circadian pattern; II, responses to feedback stimulation of HPA activity by metyrapone administration; and III, responses to tests of the effects of stress on the HPA system including the effects of hypoglycemia, induced fever, vasopressin administration, and ACTH injections and infusions. The advantages and shortcomings of each type of procedure are discussed. The second half of this paper describes the authors' attempts to establish the limits of normality of standard and modified methods of evaluating the HPA system. The defined limits of normality have been used to assess the HPA function in 158 patients with known or suspected disorders of the HPA system. In normal controls, halfhourly plasma cortisol determinations established the normality of circadian and postprandial fluctuations and of mean plasma cortisol concentration, 6.2 +/- 0.3 (SEM) micrograms/dl, which were closely approximated by determinations every 6 h. Metyrapone, given in a dose of 500 mg every 2 h for 24 h increased urinary 17-OHCS excretion to 10.5-32.6 mg/day or to 1.7-7.8 times basal excretion rate. Increasing rates of insulin infusion disclosed significant relationships between resulting plasma glucose and cortisol concentrations. The slopes of the delta cortisol/delta glucose responses were similar after insulin infusions (0.46 +/- 0.05) and after insulin injections, 0.15 U/kg (0.43 +/- 0.09), and were always greater than 0.20 micrograms/mg. This index provides a useful objective measure of the normality of responses to hypoglycemic stress, 0.20-0.87 micrograms/mg. Adrenocortical responses to iv infusions of ACTH (cosyntropin 0.25 mg) may be equivocal at 2 h but are clear cut at 4, 6 and 8 h. Of 158 patients in whom hypopituitarism was known or suspected because of the presence of a pituitary tumor, acromegaly, hyperprolactinemia, or clinical features, HPA function was found to be entirely normal in 88 patients and partially or severely abnormal in the remaining 70 patients.(ABSTRACT TRUNCATED AT 400 WORDS)

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Section: Authors' Studiesmentioning

confidence: 96%

Normal and Abnormal Function of the Hypothalamic Pituitary-Adrenocortical System in Man*

et al. 1984

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“…Other pituitary functions were assessed by a com¬ bined pituitary test (Harsoulis et al 1973), but for this report patients are classified as hypopituitary if given any form of hormone replacement therapy, based on clinical evaluation backed up by low hormone levels. None in the group of 38 patients to be reported was on hormone replacement therapy pre-implant.…”

Section: Follow-up Assessments and Methodsmentioning

confidence: 99%

Long-term effect of 90Y pituitary implantation in acromegaly

Jadresic¹,

Jimenez²,

Joplin³

1987

Acta Endocrinologica

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This report examines the long-term trends in GH levels and pituitary function in a group of 38 acromegalic patients who were selected insofar as we were able to follow them up for more than 10 years after a single dose of 90Y interstitial pituitary irradiation as the sole treatment. Mean serum GH had fallen from 106 to 24 mIU/l within 3\p=n-\6 months and then slowly declined to 4 mIU/l after 10 years. GH levels of \m=l e\5 mIU/l during a 50 g oral glucose tolerance test were obtained in 8% of patients at 3\p=n-\6months and in 18% at 1 year, the cumulative percentage increasing to 53% at 10, and 76% at 14 years. The percentage of patients requiring hormone replacement therapy rose from nil pre-implant to 16% by 3\p=n-\6 months, and then slowly increased to 39% by 14 years. Serial coned radiographs of the pituitary fossa were available for 32 patients. By 10 years, 16 showed thickening of the dorsum sellae and/or reduction of at least one diameter by 3 mm. Concerning symptoms, all 29 patients whose GH level fell to \ m=l e\ 5 mIU/l showed improvements, 22 becoming asymptomatic. Seven patients with lesser falls in GH levels (from a mean of 193 to a mean of 15 mIU/l) all improved, one becoming asymptomatic. Two showed no variation. These results show that 90Y pituitary implants have a cumulative effect over the years in inducing remission and hypopituitarism in acromegalic patients, the early decline in GH levels being swifter than from other forms of irradiation.A variety of means of treating acromegaly are available today, including surgical excision of the pituitary tumour, various forms of external or interstitial irradiation of the gland, and medical treatments. There is no clear agreement about the superiority of any particular procedure, all of them having relative merits and problems. One difficulty with making such an appraisal is the relative paucity of data for long-term trends.However, in the last few years, attention has been focussed on the long-term effects of treatment by external irradiation as evaluated by serum GH (Eastman et al. 1979;Kjellberg & Kliman 1979;Linfoot 1979;Dons et al. 1983; Feeket al. 1984).In the present study we analyse the effects of 90Y pituitary implants as the sole treatment in a group of 38 patients followed up by us for more than 10 years, in order to ascertain the time course of any decline of GH levels and any devel¬ opment of pituitary failure. We have also exam¬ ined the effect of the size and appearance of the sella turcica. This is the first time it has been possible to examine such long term effects. This analysis does not deal with the overall results nor with the early remission rate or complications as currently obtained with 90Y implants, which have already been reported (Joplin et al. 1978; Cassar étal. 1981). Patients Between 1.1. 1965 and 31.7. 1973 a total of 155 acrome¬ galie patients (79 women) were treated by implantation with 90Y in the Endocrine Unit at Hammersmith Hos¬ pital. During this period there were five operators. The planned irradiation dose at ...

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“…Patients for re-assessment of pituitary function underwent an insulin tolerance test, where there were no contraindications, with simultaneous administration of luteinising hormone/follicle stimulating hormone releasing hormone (LH/FSH-RH) and thyrotrophin releasing hormone (TRH) [12]. In view of the fact that the patients were diabetic and hypopituitary, the dose of insulin given was 0.15 units/kg body weight (Actrapid, Novo).…”

Section: Methodsmentioning

confidence: 99%

Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy

et al. 1987

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Summary. Between 1960 and 117 patients underwent pituitary implantation with yttrium-90 (90y) for treatment of proliferative retinopathy at the Hammersmith Hospital, London. Mean age at operation was 35 ___ 11 years (mean__ SD), and mean duration of diabetes 18.6_ 10.0 years. Mean insulin dosage prior to implant was 67.2+24 units, falling to 30.4 + 14.9 units post-implant. Thirty-two per cent of patients are still living, 60% are deceased and 8% are lost to followup. The 5-year survival rate was 82%. Of the causes of death, 21% died of infection, adrenal insufficiency or hypoglycaemia, 12% of renal failure, and 47% of myocardial or cerebral vascular disease. Ophthalmological follow-up was carded out on the 100 patients operated on between 1965 and 1976. The mean age of this group at implant was 35 ___ 10.5 years, and mean duration of diabetes 17.2 + 8.7 years. Visual acuity in the better eye at operation was 6/12 or better in 84% of patients, and this percentage remained similar at the time of the 5 and 10 year follow-up. Blindness (6/60 or worse) in both eyes was present in 12% of patients at the time of 5 and 10 year assessments. By 5 years new vessels on the disc had improved from a mean grading of 2.7 + 1.6 to 0.8 __-1.2 (p < 0.001), and by 10 years there was no disc neovascularisation in any eye. There was a similar improvement in the grading of hard exudates, microaneurysms and haemorrhages, but there was an increase in fibrous retinitis proliferans. It is concluded that pituitary ablation was an effective method of treating proliferative retinopathy, and may have had a beneficial effect on other microvascular complications.

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Combined Test for Assessment of Anterior Pituitary Function

Cited by 93 publications

References 17 publications

Normal and Abnormal Function of the Hypothalamic Pituitary-Adrenocortical System in Man*

Normal and Abnormal Function of the Hypothalamic Pituitary-Adrenocortical System in Man*

Long-term effect of 90Y pituitary implantation in acromegaly

Long-term follow-up of patients who underwent yttrium-90 pituitary implantation for treatment of proliferative diabetic retinopathy

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