Relationships Among the Secretion of ACTH, GH, and Cortisol During the Insulin-Induced Hypoglycemia Test in the Normal and Obese Child

Cacciari, E; Cicognani, A; Pirazzoli, Piero; Tassoni, P; Zappulla, F; Salardi, S; Bernardi, Filippo

doi:10.1210/jcem-40-5-802

Cited by 39 publications

(15 citation statements)

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“…During a 7-day total fast there was a 30% decline in plasma ACTH levels and this reduction persisted after refeeding while cortisol and CBG levels were unchanged (4). In a different study, after a 10-day fast the plasma ACTH and cortisol responses to insulin-induced hypoglycemia are markedly diminished in obese individuals in which they had previously been normal (13). However in a study of 12 women who had lost an average of 30 kg the cortisol response to insulin-induced hypoglycemia was exaggerated (57).…”

Section: Die-manipulrrtionsmentioning

confidence: 90%

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

1995

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Section: Die-manipulrrtionsmentioning

confidence: 90%

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

1995

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“…After the completion of the LH-RH or analogue treatment, those boys whose testes had failed to descend (either partially or completely) were treated with hCG, 1000IU weekly for six weeks. The pituitary reserve of gonadotropins was studied by evaluating the peak, the maximum increase and the area under the curve after LH-RH [3].…”

Section: +1 +L +1mentioning

confidence: 99%

Treatment of cryptorchidism by intranasal synthetic LH-RH and its analogue d-ser(TBU)6-LHRH-EA10

1982

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Abstract. Sixty-seven prepubertal boys with either uni-or bilateral cryptorchidism were treated with LH-RH or its analogue Hoe 766. In all cases the undescended testes were located in the inguinal canal; none had retractile testes.A) 23 boys were given 200 lag LH-RH-6 times daily for 7 days B) 24 boys were given 5001ag LH-RH-2 times daily for 7 days C) 10 boys received 100lag Hoe 766 every other day at 8 p.m.for a totaI of 8 insuffiations D) 10 boys received 25lag Hoe 766 every other day at 8 p.m.for a total of 8 insuffiations.The treatment was performed with control by LH-RH tests and testing the pituitary reserve of gonadotropins. Plasma testosterone was measured by RIA. Of the 47 boys treated with synthetic LH-RH, 14 (29.8%) gave a positive response with descent of the testes into the scrotum (A: 21.7%; B: 37.5%). The basal values and the pituitary reserves of LH and FSH did not change after therapy. Plasma testosterone showed an increase in the whole group of patients. Hoe 766 caused an increase in the FSH in all boys, but the curve was significantly higher in group C. There was no difference in plasma testosterone level between group C and D.None of the ten patients in group C responded to the therapy. In three patients of group D (30%) both testes descended. The administration of hCG to those boys who had not responded to the synthetic LH-RH or its analogue therapy led to the descent of three testes in group A and B, of two testes in group C, and of three testes in group D.Treatment of cryptorchidism by synthetic LH-RH or its analogue Hoe 766 for a short time can produce good results. The dosage of the drugs plays an important role in determining its effect.No change was found in gonadotropin secretion induced by synthetic LH-RH nasal spray therapy. The effect of intranasal administration of Hoe 766 is dose-dependent for FSH, but not for LH. When using synthetic LH-RH the best results were obtained by other authors with treatment of at least four weeks. The best results with synthetic or analogue LH-RH treatment were obtained in those subjects whose testes were located closer to the external ring. No side effects were observed either during or after the treatment.

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“…In contrast to the extensive published literature pertaining to the GH response following insulin-induced hypoglycaemia in children, comparatively few reports have considered the magnitude of the cortisol response. Furthermore, several of these studies have reported mean peak cortisol responses without reporting measures of variability, proposing reference ranges or considering factors that may enhance or impair the responses (4,5,6).…”

Section: Introductionmentioning

confidence: 99%

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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Relationships Among the Secretion of ACTH, GH, and Cortisol During the Insulin-Induced Hypoglycemia Test in the Normal and Obese Child

Cited by 39 publications

References 0 publications

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

The Hypothalamic‐Pituitary‐Adrenal Axis in Obesity

Treatment of cryptorchidism by intranasal synthetic LH-RH and its analogue d-ser(TBU)6-LHRH-EA10

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

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