Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma

2021 ◽  
Author(s):  
Kathleen D. Aldrich ◽  
Vincent E. Horne ◽  
Kevin Bielamowicz ◽  
Rona Y. Sonabend ◽  
Michael E. Scheurer ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Hormone Deficiency ◽  
Photon Radiotherapy

scholarly journals Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

2021 ◽  
Vol 66 (6) ◽  
pp. 50-58
Author(s):  
A. V. Vitebskaya ◽  
E. A. Pisareva ◽  
A. V. Popovich
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Early Morning ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucagon Test ◽  
Cortisol Levels ◽  
Glucagon And Insulin

BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation. 

scholarly journals Evaluation of adrenal function in patients with growth hormone deficiency and hypothalamic–pituitary disorders: comparison between insulin-induced hypoglycemia, low-dose ACTH, standard ACTH and CRH stimulation tests

2005 ◽  
Vol 152 (5) ◽  
pp. 735-741 ◽  
Author(s):  
M Maghnie ◽  
E Uga ◽  
F Temporini ◽  
N Di Iorgi ◽  
A Secco ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Low Dose ◽  
Clinical Symptoms ◽  
Adrenal Function ◽  
Hormone Deficiency ◽  
Cortisol Response ◽  
Normal Response ◽  
Morning Cortisol

Objectives: Patients with organic growth hormone deficiency (GHD) or with structural hypothalamic–pituitary abnormalities may have additional anterior pituitary hormone deficits, and are at risk of developing complete or partial corticotropin (ACTH) deficiency. Evaluation of the integrity of the hypothalamic–pituitary–adrenal axis (HPA) is essential in these patients because, although clinically asymptomatic, their HPA cannot appropriately react to stressful stimuli with potentially life-threatening consequences. Design and methods: In this study we evaluated the integrity of the HPA in 24 patients (age 4.2–31 years at the time of the study) with an established diagnosis of GHD and compared the reliability of the insulin tolerance test (ITT), short synacthen test (SST), low-dose SST (LDSST), and corticotropin releasing hormone (CRH) test in the diagnosis of adrenal insufficiency. Results: At a cortisol cut-off for a normal response of 550 nmol/l (20 μg/dl), the response to ITT was subnormal in 11 subjects, 6 with congenital and 5 with acquired GHD. Four patients had overt adrenal insufficiency, with morning cortisol concentrations ranging between 66.2–135.2 nmol/l (2.4–4.9 μg/dl) and typical clinical symptoms and laboratory findings. In all these patients, a subnormal cortisol response to ITT was confirmed by LDSST and by CRH tests. SST failed to identify one of the patients as adrenal insufficient. In the seven asymptomatic patients with a subnormal cortisol response to ITT, the diagnosis of adrenal insufficiency was confirmed in one by LDSST, in none by SST, and in five by CRH tests. The five patients with a normal cortisol response to ITT exhibited a normal response also after LDSST and SST. Only two of them had a normal response after a CRH test. In the seven patients with asymptomatic adrenal insufficiency mean morning cortisol concentration was significantly higher than in the patients with overt adrenal insufficiency. ITT was contraindicated in eight patients, and none of them had clinical symptoms of overt adrenal insufficiency. One of these patients had a subnormal cortisol response to LDSST, SST, and CRH, and three exhibited a subnormal response to CRH but normal responses to LDSST and to SST. Conclusion: We conclude that none of these tests can be considered completely reliable for establishing or excluding the presence of secondary or tertiary adrenal insufficiency. Consequently, clinical judgment remains one of the most important issues for deciding which patients need assessment or re–assessment of adrenal function.

scholarly journals Secondary Adrenal Insufficiency and Growth Hormone Deficiency in Patients with Fibromyalgia

2021 ◽  
Vol Volume 14 ◽  
pp. 1323-1329
Author(s):  
Lucinda M Gruber ◽  
Sanjeev Nanda ◽  
Todd Nippoldt ◽  
Alice Chang ◽  
Irina Bancos
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency

scholarly journals SUN-058 Endocrine and Metabolic Complications in 16 Taiwanese Patients with Thalassaemia Major

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Fu-Sung Lo
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Impaired Fasting Glucose ◽  
Fasting Glucose ◽  
Hormone Deficiency ◽  
Metabolic Abnormalities ◽  
Thalassaemia Major ◽  
Metabolic Complications ◽  
Metabolic Data

Abstract Backgrounds: Endocrine and metabolic abnormalities are quite common in patients with thalassaemia major, attributable, at least in part, to chronic iron overload. Endocrine and metabolic abnormalities are quite common in patients with thalassaemia major. Determining the prevalence of endocrine complications is difficult because of differences in the age of first exposure to chelation therapy, and the continuing improvement in survival in well-chelated patients.Patients and Methods: We performed a retrospective study of endocrine and metabolic data of 16 Taiwanese children (10 females and 6 males, 21.42±4.82 years) who attended in our patient clinics from Oct 2002 to Jan 2012. We analyzed height, weight, BMI, serum fasting glucose, thyroid function, growth hormone, adrenal, and gonadal functions. Results:These patients had very high serum ferritin levels with 4737.79±4572.03 ng/ml (482.8-12639). Auxological data show growth retardation (height SDS -1.05±1.34, weight SDS -0.67±0.52, BMI -0.37±0.49). Endocrine data reveal hypogonadism (n = 11, 69%), hypothyroidism (n=8, 50%), growth hormone deficiency (n=3, 19%), and adrenal insufficiency (n=3, 19%). Metabolic data show impaired fasting glucose (n=4, 25%) and diabetes (n=6, 37%). Conclusions: Patients with thalassemia major are at risk for a number of endocrine (growth hormone deficiency, hypothyroidism, adrenal insufficiency and hypogonadism) and metabolic problems (impaired fasting glucose and diabetes). It is necessary for endocrinologists to become skilled in these complications and provide long-term comprehensive care through the life of these patients.

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