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The rational use of pituitary stimulation tests
Stephan Petersenn1, Hans-Jürgen Quabbe, Christof Schöfl
1ENDOC Zentrum für Endokrine Tumoren, 20357 Hamburg, Germany. stephan.petersenn@endoc-med.de
Deutsches Arzteblatt International
|July 21, 2010
Summary
Diagnosing pituitary insufficiency requires a stepwise approach. Basal hormone levels are often sufficient for some axes, while others necessitate stimulation tests for accurate pituitary function assessment.
Area of Science:
- Endocrinology
- Neuroendocrinology
- Hormone Axis Evaluation
Background:
- Pituitary gland diseases can cause hormonal axis dysfunction and clinical symptoms.
- Standardized diagnostic methods for pituitary function are lacking.
Purpose of the Study:
- To develop standardized diagnostic outlines for evaluating pituitary hormonal axes.
- To provide guidance for assessing pituitary function in clinical practice.
Main Methods:
- Outlines for diagnostic methods were prepared by the Neuroendocrinology Section and Pituitary Study Group of the German Society of Endocrinology.
- These outlines were discussed and refined during annual meetings.
Main Results:
- Thyrotropic axis: Basal TSH and free T4 are typically sufficient.
- Gonadotropic axis: Testosterone levels in men; menstrual cycle, estradiol, and gonadotropins in women.
- Adrenocorticotropic axis: Basal cortisol; provocative testing often needed.
- Somatotropic axis: Provocative testing (e.g., insulin tolerance test, GHRH-arginine test) is required.
Conclusions:
- Diagnostic evaluation of pituitary insufficiency should be stepwise, guided by clinical presentation.
- Basal hormone levels suffice for some axes, while stimulation tests are necessary for others.
- Combined pituitary tests should be used cautiously.
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01:17The Pituitary Gland
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