Comment on Comparison of the Low Dose Short Synacthen Test (1  g), the Conventional Dose Short Synacthen Test (250  g), and the Insulin Tolerance Test for Assessment of the Hypothalamo-Pituitary-Adrenal Axis in Patients with Pituitary Disease

1999 ◽  
Vol 84 (8) ◽  
pp. 2973-2973 ◽  
Author(s):  
W. Oelkers
Keyword(s):  
Low Dose ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Adrenal Axis ◽  
Conventional Dose ◽  
Pituitary Disease ◽  
Insulin Tolerance ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

scholarly journals The Midnight to Morning Urinary Cortisol Increment Is an Accurate, Noninvasive Method for Assessment of the Hypothalamic-Pituitary-Adrenal Axis

1999 ◽  
Vol 84 (9) ◽  
pp. 3093-3098 ◽  
Author(s):  
W. M. Kong ◽  
J. Alaghband-Zadeh ◽  
J. Jones ◽  
G. Carter ◽  
D. O’Shea
Keyword(s):  
Tolerance Test ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Urinary Cortisol ◽  
Optimal Method ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Insulin Tolerance ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Pituitary Adrenal Axis

The optimal method for assessing the hypothalamic-pituitary-adrenal axis (HPA) remains controversial. The insulin tolerance test (ITT) is considered the gold standard, but is invasive and potentially dangerous. The short Synacthen test (SST) is the most commonly used alternative, but its concordance with the ITT is poor. Using sleep as a reliable stimulus to ACTH release, we proposed that the increment in urinary cortisol levels between midnight and waking could provide a noninvasive, physiological means for the assessment of the HPA axis. Double voided urine samples were collected at home at midnight and waking in 40 patients with pituitary disease and 40 controls. Cortisol and creatinine levels were measured, and the cortisol/creatinine (Cort/Cr) ratio was calculated. The Cort/Cr increment was defined as the morning Cort/Cr ratio minus the midnight Cort/Cr ratio. The Cort/Cr increment of the patients was compared to the results of their ITT or SST. Using the results from the 40 controls, a normal Cort/Cr increment was defined as greater then 9. The positive predictive value of a Cort/Cr increment for the diagnosis of HPA insufficiency was 95%. These findings suggest that the midnight to morning Cort/Cr increment is a reliable, noninvasive alternative to the ITT/SST for assessment of the HPA.

The Insulin Tolerance Test and the Ovine Corticotrophin-Releasing Hormone Test in Episodic Cluster Headache

Cephalalgia ◽  
1991 ◽  
Vol 11 (6) ◽  
pp. 269-274 ◽  
Author(s):  
Massimo Leone ◽  
Boris M Zappacosta ◽  
Sergio Valentini ◽  
Anna M Colangelo ◽  
Gennaro Bussone
Keyword(s):  
Cluster Headache ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Releasing Hormone ◽  
Autonomic Responses ◽  
Adrenal Axis ◽  
Insulin Tolerance ◽  
Basal Cortisol ◽  
Episodic Cluster Headache ◽  
Pituitary Adrenal Axis

Clinical observations indicate a central nervous system, probably hypothalamic, involvement in cluster headache pathogenesis. In order to investigate the supposed hypothalamic involvement in cluster headache, we followed the hypothalamic-pituitary-adrenal axis and autonomic responses to the insulin tolerance test and the ovine corticotrophin-releasing hormone test in episodic cluster headache patients, both during remission and during the cluster period. The study revealed increased basal cortisol levels in all cluster patients. A blunted cortisol response to ovine corticotrophin-releasing hormone, in spite of a normal ACTH surge, was subsequently found in both illness phases. These findings suggest hypo-thalamic-pituitary-adrenal axis hyperactivity in both cluster phases. Furthermore, reduced ACTH and cortisol responses after insulin challenge were also observed in both remission and cluster period patients; a reduced norepinephrine surge was seen only in the cluster period. Taken together, these results suggest a hypothalamic involvement in the altered neuroendocrinological and autonomic responses found in our patients.

scholarly journals Evaluation of Hypothalamic–Pituitary–Adrenal Axis by the GHRP2 Test: Comparison With the Insulin Tolerance Test

2018 ◽  
Vol 2 (8) ◽  
pp. 860-869
Author(s):  
Tomoaki Hayakawa ◽  
Tetsuhiro Kitamura ◽  
Daisuke Tamada ◽  
Kosuke Mukai ◽  
Reiko Hayashi ◽  
...  
Keyword(s):  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Hypothalamic Pituitary Adrenal Axis ◽  
Hypothalamic Pituitary Adrenal ◽  
Adrenal Axis ◽  
Insulin Tolerance ◽  
Pituitary Adrenal Axis

scholarly journals Response of Cortisol Metabolites in the Insulin Tolerance Test and Synacthen Tests

2015 ◽  
pp. S237-S246 ◽  
Author(s):  
K. SIMUNKOVA ◽  
M. DUSKOVA ◽  
M. KOSAK ◽  
M. KRSEK ◽  
V. HANA ◽  
...  
Keyword(s):  
Adrenal Gland ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Similar Response ◽  
Strongly Correlated ◽  
Insulin Tolerance ◽  
Stimulation Tests ◽  
Synacthen Test ◽  
Short Synacthen Test ◽  
Cortisol Metabolites

Determination of response of cortisol and its metabolites to different stimuli may be important for adrenal gland disorders. To date, only one metabolite, cortisone, has been followed in stimulation tests of the adrenal gland. We aimed to describe a response of cortisol metabolites to the standard short Synacthen test (HDST), insulin tolerance test (ITT), low dose Synacthen test (LDST) and medium dose Synacthen test (MDST). Sixty healthy subjects were investigated: 30 men and 30 women. Plasma for measurements of cortisol and its metabolites was obtained before and 30th and 60th min after Synacthen and insulin administration. The cut-off 500 nmol/l of cortisol was reached after stimulation in all of tests, the maximal stimulation level was reached in 60th min in all of the tests except for LDST. The response of cortisol and its metabolites at 30th and 60th min strongly correlated in all of the tests except for LDST. Cortisol and its metabolites increased after stimulation; in contrast, cortisone and its metabolites decreased. We showed that the response of the cortisol metabolites during the Synacthen tests and ITT well correlated, and the MDST showed similar response compared to HDST. The decrease in cortisone metabolites may correspond to the regeneration of cortisol from cortisone in response to stimulation test.

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