A comparison of the insulin tolerance/glucagon test with the short ACTH stimulation test in the assessment of the hypothalamo‐pituitary‐adrenal axis in the early post‐operative period after hypophysectomy

The insulin tolerance test (ITT) is the established reference test for assessing the hypothalamo‐pituitary‐adrenal (HPA) axis. Various authorities, however, have suggested that the 250 μg short ACTH stimulation test may be used to assess the HPA axis in place of the ITT in suspected hypopituitarism, although a number of other studies have suggested that the test may be unreliable in this setting. In this study, the ITT (or glucagon test) has been compared with the 250 μg short ACTH stimulation test in patients with pituitary tumours pre‐operatively and within 2 weeks of trans‐sphenoidal hypophysectomy.

[1]  M. Scanlon,et al.  A comparison between short ACTH and insulin stress tests for assessing hypothalamo‐pituitary‐adrenal function , 1996, Clinical endocrinology.

[2]  R. Clayton,et al.  Short Synacthen test versus insulin stress test for assessment of the hypothalmo–pituitary–adrenal axis: controversy revisited , 1996 .

[3]  E. Hägg,et al.  A low dose ACTH test to assess the function of the hypothalamic–pituitary–adrenal axis , 1996, Clinical endocrinology.

[4]  S. Hurel,et al.  The short Synacthen and insulin stress tests in the assessment of the hypothalamic–pituitary–adrenal axis , 1996, Clinical endocrinology.

[5]  S. Soule,et al.  Failure of the short ACTH test to unequivocally diagnose long‐standing symptomatic secondary hypoadrenalism , 1996, Clinical endocrinology.

[6]  N. Stern,et al.  The role of the low dose (1 microgram) adrenocorticotropin test in the evaluation of patients with pituitary diseases. , 1995, The Journal of clinical endocrinology and metabolism.

[7]  A. Grossman,et al.  An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year , 1994, Clinical endocrinology.

[8]  C. Edwards,et al.  A RATIONAL APPROACH FOR ASSESSING THE HYPOTHALAMO-PITUITARY-ADRENAL AXIS , 1988, The Lancet.

[9]  G. Besser,et al.  Measurement of circulating corticotrophin-releasing factor in man. , 1987, The Journal of endocrinology.

[10]  H. Kehlet,et al.  RE‐EVALUATION OF THE CLINICAL VALUE OF THE 30 MIN ACTH TEST IN ASSESSING THE HYPOTHALAMIC‐PITUITARY‐ADRENOCORTICAL FUNCTION , 1987, Clinical endocrinology.

[11]  T. Mckenna,et al.  Normal cortisol response to corticotropin in patients with secondary adrenal failure. , 1983, Archives of internal medicine.

[12]  H. Kehlet,et al.  Value of the 30-minute adrenocorticotropin (ACTH) test in demonstrating hypothalamic-pituitary-adrenocortical insufficiency after acute ACTH deprivation. , 1983, The Journal of clinical endocrinology and metabolism.

[13]  A. Catania,et al.  Plasma Cortisol response to ACTH does not accurately indicate the state of hypothalamic-pituitary-adrenal axis , 1982, Journal of endocrinological investigation.

[14]  J. O'brian,et al.  Discordant cortisol response to exogenous ACTH and insulin-induced hypoglycemia in patients with pituitary disease. , 1982, The New England journal of medicine.

[15]  H. Kehlet,et al.  Reliability of the 30-minute ACTH test in assessing hypothalamic-pituitary-adrenal function. , 1978, The Journal of clinical endocrinology and metabolism.

[16]  H. Kehlet,et al.  Value of an ACTH Test in Assessing Hypothalamic-Pituitary-Adrenocortical Function in Glucocorticoid-treated Patients , 1973, British medical journal.

[17]  G. Besser,et al.  Corticosteroid treatment and surgery. 1. An investigation of the indications for steroid cover. , 1970, Anaesthesia.

[18]  G. Besser,et al.  The adrenocortical response to surgery and insulin‐induced hypoglycaemia in corticosteroid‐treated and normal subjects , 1969, The British journal of surgery.

[19]  W. Buchanan,et al.  STUDIES OF THE RISE IN PLASMA 11-HYDROXYCORTICOSTEROIDS (11-OHCS) IN CORTICOSTEROID-TREATED PATIENTS WITH RHEUMATOID ARTHRITIS DURING SURGERY: CORRELATIONS WITH THE FUNCTIONAL INTEGRITY OF THE HYPOTHALAMO-PITUITARY-ADRENAL AXIS , 1968 .

[20]  M. Wharton,et al.  Threshold adrenocortical sensitivity in man and its possible application to corticotrophin bioassay. , 1967, Lancet.

[21]  J. Landon,et al.  The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin. I. In control subjects. , 1966, The Journal of clinical investigation.

[22]  V. Wynn,et al.  The plasma sugar, free fatty acid, cortisol, and growth hormone response to insulin, and the comparison of this procedure with other tests of pituitary and adrenal function. II. In patients with hypothalamic or pituitary dysfunction or anorexia nervosa. , 1966, The Journal of clinical investigation.

[23]  V. Wynn,et al.  ADRENOCORTICOTROPIC EFFECTS OF A SYNTHETIC POLYPEPTIDE--BETA 1-24-CORTICOTROPIN--IN MAN. , 1964, The Journal of clinical endocrinology and metabolism.

[24]  D. Leak,et al.  The mechanism of arrhythmias during insulin-induced hypoglycemia. , 1962, American heart journal.