The insulin hypoglycaemia test for the assessment of the hypothalamic–pituitary–adrenal function

Lindholm, Jörgen

doi:10.1046/j.1365-2265.2001.01163.x

Cited by 18 publications

(15 citation statements)

References 47 publications

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“…However, all AS2 patients had an insufficient decrease in plasma glucose levels (.50% of basal values) and thus they did not meet the criteria of a successful IIH test. 11 Insulin administration was followed by significant (p,0.001) changes in plasma glucose in both AS1 and control groups. The general linear model test showed differences in the course of the changes of plasma glucose in AS1 patients (F = 5.484, p = 0.041) compared with the controls.…”

Section: Resultsmentioning

confidence: 90%

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Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

Imrich

Rovenský²,

Zlnay³

et al. 2004

Annals of the Rheumatic Diseases

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Objective: To assess basal function and responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis in patients with ankylosing spondylitis during dynamic testing. Methods: Insulin induced hypoglycaemia (IIH) (Actrapid HM 0.1 IU/kg, as intravenous bolus) was induced in 17 patients and 11 healthy controls matched for age, sex, and body mass index. Concentrations of glucose, adrenocorticotrophic hormone (ACTH), cortisol, insulin, dehydroepiandrosterone sulphate (DHEAS), 17a-hydroxyprogesterone, interleukin 6 (IL-6), and tumour necrosis factor a (TNFa) were determined in plasma. Results: Comparable basal cortisol levels were found in the two groups, with a trend to be lower in ankylosing spondylitis. In the ankylosing spondylitis group, there were higher concentrations of IL-6 (mean (SEM): 16.6 (2.8) pg/ml v 1.41 (0.66) pg/ml in controls; p,0.001) and TNFa (8.5 (1.74) pg/ml v 4.08 (0.42) pg/ml in controls; p,0.01). Glucose, insulin, ACTH, DHEAS, and 17a-hydroxyprogesterone did not differ significantly from control. The IIH test was carried out successfully in 11 of the 17 patients with ankylosing spondylitis, and the ACTH and cortisol responses were comparable with control. General linear modelling showed a different course of glycaemia (p = 0.041) in the ankylosing spondylitis patients who met the criteria for a successful IIH test compared with the controls. Conclusions:The results suggest there is no difference in basal HPA axis activity and completely preserved responsiveness of the HPA axis in patients with ankylosing spondylitis. The interpretation of the different course of glycaemia during IIH in ankylosing spondylitis requires further investigation.A nkylosing spondylitis is a rheumatic disorder which typically affects the sacroiliac joints and the spine. It belongs to the group of spondylarthropathies with a higher prevalence in men. A strong association with the major histocompatibility complex class I molecule HLA B-27, together with hereditary, environmental, and other factors including endocrine perturbations, may operate in the pathogenesis of ankylosing spondylitis.1 Detailed relations are, however, still unclear.During the past decade data have accumulated suggesting a role for the neuroendocrine system in the pathogenesis of rheumatic diseases. Studies in patients with rheumatoid arthritis broadly support the hypothesis that the hypothalamic-pituitary-adrenal (HPA) axis plays a critical role in counterregulation of immune inflammatory processes. Thus dysregulation of the HPA axis response is likely to predispose individuals to the onset of chronic inflammatory diseases including ankylosing spondylitis, or to affect their severity. In contrast to rheumatoid arthritis, few published reports have addressed HPA axis activity in ankylosing spondylitis.The activity of the HPA axis is regarded as inappropriately normal with respect to the ongoing inflammation in rheumatoid arthritis.4 Decreased HPA axis activity seems to result from relative adrenal insufficiency, as reported in a subset of younger w...

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Section: Resultsmentioning

confidence: 90%

“…This provides an opportunity to assess the response of the HPA axis at both pituitary and adrenal level. 11 A drawback of the IIH test is that subjects with insulin resistance that is not clinically apparent could have an inadequate decrease in glycaemia, which may be insufficient to trigger a neuroendocrine response.…”

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confidence: 99%

Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

Imrich

Rovenský²,

Zlnay³

et al. 2004

Annals of the Rheumatic Diseases

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“…There are a variety of classical and new functional tests to assess the GH secretory capacity 3 . However, due to the symptomatic hypoglycemia required for the accurate interpretation of the test, the ITT is associated with unpleasant and even hazardous side effects and requires constant supervision by medical staff 9 . Furthermore, it provides the advantage of parallel assessment of the Cortisol secretion capacity of the adrenal gland.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Adrenal Function Tests in Children - The Glucagon Stimulation Test Allows the Simultaneous Assessment of Adrenal Function and Growth Hormone Response in Children

Böttner¹,

Kratzsch²,

Liebermann³

et al. 2005

Journal of Pediatric Endocrinology and Metabolism

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The accurate assessment of adrenal function is necessary in many children with suspicion of pituitary insufficiency. The objective of this study was to evaluate the adrenal response during the glucagon stimulation test (GST) and its diagnostic utility in children. A total of 290 children, aged 10.1 +/- 5.0 years, were evaluated for adrenal function using the corticotrophin releasing hormone (CRH) test, the GST, and/or the insulin tolerance test (ITT). Glucagon stimulation provoked a substantial rise in cortisol and adrenocorticotropin (ACTH) that was independent of gender, age, or underlying growth hormone deficiency. There were no differences in peak cortisol levels in the GST compared to the CRH test in pair-wise intra-individual analyses in children with both tests performed within one year (615.4 +/- 30.5 vs 602.8 +/- 22.4 nmol/l, n=52). Similarly, there were no differences in the cortisol response between the ITT and CRH test. Peak cortisol levels in the CRH test correlated with the GST and the ITT. The magnitude of ACTH response, in contrast, was highest in the ITT with a 9.8-fold increase over baseline, while the increase in the GST (3.1-fold) and CRH test (1.6-fold) were more subtle. Since there is controversy concerning reliable cut-off values for adrenal function tests in children, we analyzed cut off levels in 186 children, including 26 children with adrenal insufficiency, using the CRH test. A peak cortisol level of 450 nmol/l provided the best balance of sensitivity (88.5%) and specificity (86.8%), while higher cut-off levels did not increase sensitivity but lost in specificity. In summary, the GST constitutes an1 equally sensitive test for the assessment of adrenal function in children that is not confounded by anthropometric parameters and is generally not accompanied by major side effects. It allows the simultaneous assessment of corticotroph and somatotroph function and may thus constitute a valuable alternative to the ITT.

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“…However, hypopituitarism may be an independent risk factor for mortality, particularly due to cerebrovascular causes (Rosen & Bengtsson 1990, Bates et al 1996, 1999, Bulow et al 1997, Erfurth et al 2000, 2001, Tomlinson et al 2001, Brada et al 2002. Cerebrovascular accidents in cohorts with hypopituitarism are more common in women and in untreated hypogonadal patients of both sexes (Tomlinson et al 2001, Lindholm et al 2006, Nielsen et al 2007).…”

Section: Hypopituitarism and Mortalitymentioning

confidence: 99%

Radiation-induced hypopituitarism

Fernández¹,

Brada²,

Zabuliene³

et al. 2009

Endocrine-Related Cancer

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The hypothalamic-pituitary unit is a particularly radiosensitive region in the central nervous system. As a consequence, hypopituitarism commonly develops after radiation treatments for sellar and parasellar neoplasms, extrasellar brain tumours, head and neck tumours, and following whole body irradiation for systemic malignancies. Increasing tumour-related survival rates provide an expanding population at risk of developing hypopituitarism. In this population, long-term monitoring tailored to the individual risk profile is required to avoid the sequelae of untreated pituitary hormonal deficiencies and resultant decrease in the quality of life. This review analyses the pathogenesis, prevalence and consequences of radiation-induced hypopituitarism (RIH) in diverse subgroups at risk. Also discussed is the impact of modern radiotherapy techniques in the prevalence of RIH, the spectrum of endocrine disorders and radiation-induced brain conditions that also occur in patients with RIH.

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The insulin hypoglycaemia test for the assessment of the hypothalamic–pituitary–adrenal function

Cited by 18 publications

References 47 publications

Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

Hypothalamic-pituitary-adrenal axis function in ankylosing spondylitis

Comparison of Adrenal Function Tests in Children - The Glucagon Stimulation Test Allows the Simultaneous Assessment of Adrenal Function and Growth Hormone Response in Children

Radiation-induced hypopituitarism

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