Endocrine and neurophysiologic responses of the pituitary to insulin-induced hypoglycemia: A review

Fish, Hamilton R.; Chernow, Bart; O’Brian, John T.

doi:10.1016/0026-0495(86)90245-3

Cited by 124 publications

(93 citation statements)

References 260 publications

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“…The ACTH response to hypoglycaemia is mediated through activation of alpha adrenergic [122] and serotonergic neural inputs [ 1231 whilst opiate [ 1 191 adrenergic [ 12 I] and cholinergic [ 1 241 inputs are inhibitory. The growth hormone response to IIH is augmented by u P 2 adrenergic, serotonergic and opio-dergic activation whilst beta adrenergic input are inhibitory [125]. Less is known about the neurophysiological control of the prolactin response to IIH apart from the involvement of an inhibitory dopaminergic input [125].…”

Section: Stress and Cfsmentioning

confidence: 99%

“…The growth hormone response to IIH is augmented by u P 2 adrenergic, serotonergic and opio-dergic activation whilst beta adrenergic input are inhibitory [125]. Less is known about the neurophysiological control of the prolactin response to IIH apart from the involvement of an inhibitory dopaminergic input [125]. Thus, neuroendocrine responses to IIH provide a 'net' measure of many neural influences on hypothalamo-pituitary function, acting in concert in response to stress, rather than reflecting a discrete neural function response to stress.…”

Section: Stress and Cfsmentioning

confidence: 99%

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Neurobiological aspects of the chronic fatigue syndrome

Bearn

Wessely

1994

Eur J Clin Investigation

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Section: Stress and Cfsmentioning

confidence: 99%

Section: Stress and Cfsmentioning

confidence: 99%

Neurobiological aspects of the chronic fatigue syndrome

Bearn

Wessely

1994

Eur J Clin Investigation

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“…The insulin tolerance test (ITT) is the gold standard test for examining HPA axis function (1)(2)(3). It is used in the preoperative and postoperative assessment of patients with pituitary adenoma.…”

Section: Introductionmentioning

confidence: 99%

Can basal cortisol measurement be an alternative to the insulin tolerance test in the assessment of the hypothalamic–pituitary–adrenal axis before and after pituitary surgery?

Karaca

Tanrıverdi²,

Atmaca³

et al. 2010

European Journal of Endocrinology

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Background: The aims of this study were to evaluate the validity of preoperative basal serum cortisol levels measured in predicting preoperative adrenal insufficiency and also the validity of basal serum cortisol levels and early postoperative insulin tolerance test (ITT) in predicting postoperative adrenal insufficiency. Methods: The study was prospectively designed and included 64 patients who underwent pituitary surgery for conditions other than Cushing's disease. An ITT was performed preoperatively, on the 6th postoperative day and at the 1st postoperative month. Basal serum cortisol levels were measured on the 2nd, 3rd, 4th, 5th, and 6th postoperative days. Results: Patients with a preoperative basal cortisol level of !165 nmol/l (6 mg/dl) showed insufficient cortisol response and those with levels higher than 500 nmol/l (18 mg/dl) had sufficient cortisol response to the preoperative ITT. The positive predictive value of the ITT performed on the 6th postoperative day was 69.7%, and the negative predictive value in predicting adrenal insufficiency at the 1st postoperative month was 58%. Patients were considered to have an insufficient cortisol response to ITT at the 1st postoperative month if their basal cortisol levels were !193 nmol/l (7 mg/dl) or 220 nmol/l (8 mg/dl) or 193 nmol/l (7 mg/dl) or 165 nmol/l (6 mg/dl) or 83 nmol/l (3 mg/dl) on the 2nd-6th postoperative days respectively. Conclusion: Serum basal cortisol levels may be used as the first-line test in the assessment of the hypothalamic-pituitary-adrenal axis both preoperatively and postoperatively. Dynamic testing should be limited to the patients with indeterminate basal cortisol levels.

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“…Patients with a baseline cortisol of > 500 nmol.l ¹1 were uniformly shown to have a normal cortisol response to ITT. Fish and colleagues reviewed 6580 ITTs and found only six cases with untoward sideeffects (two comas, two episodes of angina and two impending seizures) [79]. All were reversed with glucose administration intravenously.…”

Section: The Insulin Tolerance Test (Itt)mentioning

confidence: 99%