Evaluation of adrenal function in patients with hypothalamic and pituitary disorders: comparison of serum cortisol, urinary free cortisol and the human‐corticotrophin releasing hormone test with the insulin tolerance test

Dullaart, Robin P. F.; Pasterkamp, Susanne H.; Beentjes, Jam; Sluiter, Wim J.

doi:10.1046/j.1365-2265.1999.00679.x

Cited by 51 publications

(39 citation statements)

References 29 publications

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“…The diagnosis of secondary AI was based on internationally accepted biochemical criteria, principally early morning (08.00-09.00 h) serum cortisol measurements and, if necessary, an insulin tolerance test. Early morning cut-off cortisol levels for AI in our center were validated for patients with hypothalamic-pituitary disorders as published previously [15]. Other pituitary hormone deficiencies were adequately replaced when necessary for at least 6 months prior to study entry and treatment remained stable during the study.…”

Section: Methodsmentioning

confidence: 99%

Hydrocortisone Dose Influences Pain, Depressive Symptoms and Perceived Health in Adrenal Insufficiency: A Randomized Controlled Trial

Buning

Brummelman²,

Koerts

et al. 2015

Neuroendocrinology

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Background: There is a major lack of randomized controlled trials (RCTs) evaluating the effects of hydrocortisone (HC) substitution therapy in patients with secondary adrenal insufficiency. Therefore, we evaluated the effects of two different replacement doses of HC on health-related quality of life (HRQoL) in a RCT. Methods: This RCT with a double-blind cross-over design was performed at the University Medical Center Groningen. Forty-seven patients (29 men, age 51 ± 14 years, range 19-73 years) with secondary adrenal insufficiency participated. Patients received both a lower and a higher dose of HC (0.2-0.3 and 0.4-0.6 mg/kg body weight/day) for 10 weeks in random order. HRQoL was assessed with a daily mood and symptom checklist (Patient Health Questionnaire-15 [PHQ-15], Generalized Anxiety Disorder-7 [GAD-7], Patient Health Questionnaire-9 [PHQ-9]) and with questionnaires assessing general well-being (RAND 36-Item Health Survey [RAND-36]), mood (Hospital Anxiety and Depression Scale [HADS]) and fatigue (Multidimensional Fatigue Inventory-20 [MFI-20]). ClinicalTrials.gov identifier: NCT01546922. Results: Patients receiving the higher dose of HC reported significantly fewer symptoms of depression (p = 0.016 and p = 0.045 for HADS and PHQ-9, respectively), less general and mental fatigue (p = 0.004 and p = 0.003, respectively, both MFI-20), increased motivation (p = 0.021, MFI-20), better physical functioning (p = 0.041), better general health (p = 0.013) and more vitality (p = 0.025) (all RAND-36). In addition, while on the higher dose, fewer somatic symptoms (p = 0.022) and less pain (p < 0.001) (both PHQ-15) were experienced. Conclusions: On the higher dose of HC, patients reported a better HRQoL on various domains as compared to the lower dose of HC. The fact that a higher dose of HC may improve patient well-being should be taken into consideration when individualizing the HC substitution dose.

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Section: Methodsmentioning

confidence: 99%

Hydrocortisone Dose Influences Pain, Depressive Symptoms and Perceived Health in Adrenal Insufficiency: A Randomized Controlled Trial

Buning

Brummelman²,

Koerts

et al. 2015

Neuroendocrinology

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“…The ITT, however, is unpleasant, highly resource intensive as it needs medical supervision and is contraindicated in infants, patients with a history of seizures and cardiovascular disease and may occasionally give misleading results 2 3. Human corticotrophin-releasing hormone (hCRH) test is also found to be an acceptable method to assess the HPA axis as the CRH stimulates the HPA axis at a higher anatomical level than ACTH 4 5. However, this method is rarely used in the paediatric setting and there is currently no consensus about what is the most appropriate test for assessing the integrity of the HPA axis in children 6.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children

Agwu

Dwan

2016

Arch Dis Child

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Lack of standardisation of assays and protocols with regard to timing, frequency and dose has resulted in diagnostic inaccuracies. There is no clear evidence to indicate that LDSST is superior to SSST in the assessment of HPA axis in children. The choice of either SSST or LDSST should be individualised based on clinical judgement for each patient. This systematic review has identified the need for a well-designed, adequately powered, randomised controlled trial on the use of diagnostic tests used in assessing HPA axis in children.

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“…Finally, studies of dynamic CRH testing in other clinical situations of hypothalamic-pituitary insufficiency (i.e., not postoperative) have also reported contradictory results with regard to CRH response rates. 22,39,53 In general, results have been highly variable in determining useful criteria for evaluating CRH stimulation data, and there has been no established added benefit over measurement of static serum cortisol levels. 37,38 …”

Section: Crh Stimulationmentioning

confidence: 99%

Cushing's disease: predicting long-term remission after surgical treatment

Pendharkar¹,

Sussman²,

Ho³

et al. 2015

FOC

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Cushing's disease (CD) is a state of excess glucocorticoid production resulting from an adrenocorticotropic hormone (ACTH)–secreting pituitary adenoma. The gold-standard treatment for CD is transsphenoidal adenomectomy. In the hands of an experienced neurosurgeon, gross-total resection is possible in the majority of ACTH-secreting pituitary adenomas, with early postoperative remission rates ranging from 67% to 95%. In contrast to the strong data in support of resection, the clinical course of postsurgical persistent or recurrent disease remains unclear. There is significant variability in recurrence rates, with reports as high as 36% with a mean time to recurrence of 15–50 months. It is therefore important to develop biochemical criteria that define postsurgical remission and that may provide prognosis for long-term recurrence. Despite the use of a number of biochemical assessments, there is debate regarding the accuracy of these tests in predicting recurrence. Here, the authors review the various biochemical criteria and assess their utility in predicting CD recurrence after resection.

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Evaluation of adrenal function in patients with hypothalamic and pituitary disorders: comparison of serum cortisol, urinary free cortisol and the human‐corticotrophin releasing hormone test with the insulin tolerance test

Abstract: Serum cortisol measurement at 0800 h is better than 1600 h and 24-h urinary free cortisol to evaluate adrenal function in this patient category. The diagnostic applicability of the h-CRH test is not superior to 0800 h serum cortisol measurement.

Cited by 51 publications

References 29 publications

Hydrocortisone Dose Influences Pain, Depressive Symptoms and Perceived Health in Adrenal Insufficiency: A Randomized Controlled Trial

Hydrocortisone Dose Influences Pain, Depressive Symptoms and Perceived Health in Adrenal Insufficiency: A Randomized Controlled Trial

A systematic review and meta-analysis of Synacthen tests for assessing hypothalamic-pituitary-adrenal insufficiency in children

Cushing's disease: predicting long-term remission after surgical treatment

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