Selective use of the insulin tolerance test to diagnose hypopituitarism.

Abstract

The insulin tolerance test is considered the gold standard for assessing the hypothalamic-pituitary-adrenal and growth hormone (GH) axes, but its use varies considerably among different endocrine units. We recommend using the insulin tolerance test to assess the hypothalamic-pituitary-adrenal axis within 3 months of pituitary surgery, where adrenocorticotropic hormone 1-24 testing is equivocal, and to assess for GH deficiency where the patient is being considered for GH replacement therapy. We also discuss safety issues, how to ensure adequate hypoglycaemia and possible alternative tests, such as the overnight metyrapone test and glucagon test.

• Authors: S Sarlos, W J Inder
• Journal: Internal medicine journal (Intern Med J) Vol. 43 Issue 1 Pg. 89-93 (Jan 2013) ISSN: 1445-5994 [Electronic] Australia
• PMID: 23324090 (Publication Type: Journal Article, Review)
• Copyright: © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Chemical References

• Insulin
• Human Growth Hormone
• Cosyntropin
• Insulin-Like Growth Factor I
• Adrenocorticotropic Hormone
• Glucagon
• Hydrocortisone
• Metyrapone

Topics

• Adrenocorticotropic Hormone (deficiency)
• Circadian Rhythm
• Contraindications
• Cosyntropin
• False Negative Reactions
• Glucagon
• Human Growth Hormone (deficiency, economics, metabolism, therapeutic use)
• Humans
• Hydrocortisone (metabolism)
• Hypoglycemia (chemically induced)
• Hypophysectomy
• Hypopituitarism (diagnosis, etiology)
• Hypothalamo-Hypophyseal System (physiopathology)
• Insulin (administration & dosage, adverse effects)
• Insulin-Like Growth Factor I (analysis)
• Metyrapone
• Pituitary Function Tests (adverse effects, methods)
• Pituitary-Adrenal System (physiopathology)
• Postoperative Complications (diagnosis, etiology)