Key result
Insulin tolerance testing is recommended within 3 months of pituitary surgery when ACTH is equivocal.
Why the study?
The use of the insulin tolerance test to assess hypothalamic-pituitary-adrenal and growth hormone axes varies considerably among endocrine units, necessitating guidance on selective use.
When should the insulin tolerance test be used to diagnose hypopituitarism?
When should the insulin tolerance test be used to diagnose hypopituitarism?
The insulin tolerance test remains a recommended diagnostic tool for assessing the hypothalamic-pituitary-adrenal and growth hormone axes in specific clinical scenarios.
Answers are grounded in this paper and cite their sources.
Supports selective ITT post-pituitary surgery when ACTH equivocal; leaves open prospective validation for hypopituitarism diagnosis.
The insulin tolerance test is considered the gold standard for assessing the hypothalamic-pituitary-adrenal and growth hormone (GH) axes, but its use varies considerably among different endocrine units. We recommend using the insulin tolerance test to assess the hypothalamic-pituitary-adrenal axis within 3 months of pituitary surgery, where adrenocorticotropic hormone 1-24 testing is equivocal, and to assess for GH deficiency where the patient is being considered for GH replacement therapy. We also discuss safety issues, how to ensure adequate hypoglycaemia and possible alternative tests, such as the overnight metyrapone test and glucagon test.
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Sarlos et al. (2013) conducted a review in Hypopituitarism. Insulin tolerance test was evaluated. The insulin tolerance test is recommended to assess the hypothalamic-pituitary-adrenal axis within 3 months of pituitary surgery when ACTH testing is equivocal, and to assess for GH deficiency.
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