Pituitary Response to Hypoglycemia in Pituitary Diseases

Genazzani, Ar; Rüedi, B; Ml, Aubert; Jp, Felber

doi:10.1055/s-0028-1094008

Cited by 8 publications

(3 citation statements)

References 2 publications

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“…Peak cortisol responses occurred at T C60 in 66% of our cohort, in accordance with other studies (8), and peak cortisol responses at T C35 after insulin administration occurred in only 13%. In addition, a lack of relationship between ACTH and cortisol was also demonstrated, in accordance with other small studies (16,17). It has been proposed that a small sample size and the assumption that the relationship between ACTH and cortisol is linear rather than logarithmic may be responsible for such an observation (18).…”

Section: Discussionsupporting

confidence: 70%

Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

O’Grady

Hensey

Fallon

et al. 2013

European Journal of Endocrinology

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Objective: Based on adult data, a peak cortisol response R500 nmol/l to insulin-induced hypoglycaemia constitutes a normal. Age-specific reference ranges for basal morning cortisol have been developed for clinical use in the paediatric population. Such reference ranges are not clearly established for peak cortisol responses to insulin-induced hypoglycaemia despite limited data suggesting an effect of age on peak cortisol. The aims of this study were to assess factors affecting the cortisol response to insulin-induced hypoglycaemia in children and to determine whether the peak cortisol response was related to age. Design: The present study was a retrospective cohort study. Methods: Retrospective analysis of children and adolescents aged %18 years undergoing the insulin tolerance test with adequate hypoglycaemia was undertaken. Patients with hypopituitarism or severe hypothalamic-pituitary-adrenal axis impairment (peak cortisol value !400 nmol/l) or using systemic glucocorticoids were excluded. Results: Two hundred and twenty-three tests were analysed. Peak cortisol responses R500 nmol/l occurred in 183 (82%) tests. Age was negatively associated with peak cortisol responses (rZK0.15, PZ0.03). A peak cortisol response !500 nmol/l was significantly less common in patients aged !12 years (9/97 (9%) vs 31/126 (25%); PZ0.004). In children aged !12 years, the median (5th-95th centiles) peak cortisol values were 610 (480-806) nmol/l compared with 574 (442-789) nmol/l in children aged R12 years (P!0.004). Similarly, median cortisol increment was significantly higher in younger patients (301 nmol/l compared with 226 nmol/l (PZ0.0004)). Conclusions: Use of a single peak cortisol threshold in children of all ages is not appropriate and will result in overdiagnosis of adrenal insufficiency in adolescents.

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Section: Discussionsupporting

confidence: 70%

Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

O’Grady

Hensey

Fallon

et al. 2013

European Journal of Endocrinology

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“…The children with persistent GH deficiency showed almost no ACTH response, while children with transitory GH deficiency generally had a normal response. This significant difference is in contrast to previous conflicting results (1,3,6,8,17). None of the patients had clinical signs of adrenal insufficiency, but the demonstration of lack of ACTH response during hypoglycemia in children with persistent GH deficiency suggests the possibility of adrenal insufficiency during stress.…”

Section: Acth Secretioncontrasting

confidence: 86%

COMBINED TEST OF HYPOTHALAMIC‐PITUITARY FUNCTION IN GROWTH‐RETARDED CHILDREN TREATED WITH GROWTH HORMONE: II. Secretion of LH, FSH, TSH, Prolactin and ACTH

et al. 1979

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Abstract. P. C. Eskildsen, B. B. Jacobsen, K. W. Kastrup, S. Krabbe, P. E. Lebech and K. E. Petersen (The Children's Hospital Fuglebakken, Herlev Hospital and Frederiksberg Hospital, Copenhagen, Denmark). Combined test of hypothalamic‐pituitary function in growth‐retarded children treated with growth hormone. Acta Paediatr Scand, Suppl. 277: 14, 1979.—A total number of 23 patients treated with human growth hormone were retested by use of a combined pituitary stimulation test. Plasma concentrations of GH, FSH, LH, TSH, T4, T3, prolactin (PRL), ACTH and cortisol were measured before and after stimulation with hypoglycemia, TRH and LHRH. The test was performed in patients with persistent GH deficiency (group A) and patients with transitory GH deficiency (group B). In group A a normal pubertal development was found in three patients, whereas in prepubertal subjects the FSH/LH responses were smaller than those of prepubertal patients in group B. Also plasma ACTH increase was less pronounced in group A patients than in group B. In contrast, the plasma TSH and PRL responses were more sustained in group A than in group B. The secretory pattern of TSH and PRL was comparable in the two groups of patients. Thus, in patients with persistent GH deficiency additional multiple disturbances of the hypothalamic‐pituitary function often appeared whereas in most patients with transitory GH deficiency the combined pituitary test was normal at the reinvestigation.

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“…The HCS radioimmunoassay was performed according to Genazzani et al (1971) using the CEA-CEN Sorin kit. All the plasma samples were diluted from 1 :25 to 1 : 400 with 0.04 M phosphate buffer containing 0.1 % bovine serum albumin (Armour) depending upon the number of weeks of pregnancy (Genazzani et al, 1972b).…”

Section: A T E R I a L S A N D M E T H O D S Assaysmentioning

confidence: 99%

Immunoreactive Acth and Cortisol Plasma Levels During Pregnancy. Detection and Partial Purification of Corticotrophin‐like Placental Hormone: The Human Chorionic Corticotropin (Hcc)

Genazzani

Fraioli²,

Hürlimann

et al. 1975

Clinical Endocrinology

125

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The high plasma cortisol and ACTH levels present in pregnant women as well as the non-parrallelism of their plasma extract dilution curves in comparison with the standard curve in the ACTH radioimmunoassay, are evidence for the presence of an ACTH-like substance during pregnancy which would interfere with the assay. Placental extracts were obtained by acid-acetone extraction, followed by partial purification with oxycellulose and by extraction with porous glass powder. A substance was detected which partially cross-reacted with synthetic human ACTH in the radioimmunoassay and which showed biological activity using the assay procedure described by Liscomb & Nelson. The data sustain the existence of an ACTH-like placental hormone: human chorionic corticotrophin (HCC).

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Pituitary Response to Hypoglycemia in Pituitary Diseases

Cited by 8 publications

References 2 publications

Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

Requirement for age-specific peak cortisol responses to insulin-induced hypoglycaemia in children

COMBINED TEST OF HYPOTHALAMIC‐PITUITARY FUNCTION IN GROWTH‐RETARDED CHILDREN TREATED WITH GROWTH HORMONE: II. Secretion of LH, FSH, TSH, Prolactin and ACTH

Immunoreactive Acth and Cortisol Plasma Levels During Pregnancy. Detection and Partial Purification of Corticotrophin‐like Placental Hormone: The Human Chorionic Corticotropin (Hcc)

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