How should we interrogate the hypothalamic-pituitary-adrenal axis in patients with suspected hypopituitarism?

Abstract

Hypopituitarism is deficiency of one or more pituitary hormones, of which adrenocorticotrophic hormone (ACTH) deficiency is the most serious and potentially life-threatening. It may occur in isolation or, more commonly as part of more widespread pituitary failure. Diagnosis requires demonstration of subnormal cortisol rise in response to stimulation with hypoglycemia, glucagon, ACTH(1-24) or in the setting of acute illness. The choice of diagnostic test should be individualised for the patient and clinical scenario. A random cortisol and ACTH level may be adequate in making a diagnosis in an acutely ill patient with a suspected adrenal crisis e.g. pituitary apoplexy. Often however, dynamic assessment of cortisol reserve is needed. The cortisol response is both stimulus and assay- dependent and normative values should be derived locally. Results must be interpreted within clinical context and with understanding of potential pitfalls of the test used.

• Authors: Aoife Garrahy, Amar Agha
• Journal: BMC endocrine disorders (BMC Endocr Disord) Vol. 16 Issue 1 Pg. 36 (Jun 17 2016) ISSN: 1472-6823 [Electronic] England
• PMID: 27316460 (Publication Type: Journal Article, Review)

Chemical References

• Adrenocorticotropic Hormone
• Hydrocortisone

Topics

• Adrenocorticotropic Hormone (blood, deficiency)
• Humans
• Hydrocortisone (blood)
• Hypoglycemia (metabolism, physiopathology)
• Hypopituitarism (diagnosis, metabolism)
• Hypothalamo-Hypophyseal System (metabolism, physiopathology)
• Pituitary-Adrenal System (metabolism, physiopathology)
• Stress, Physiological