Title |
How should we interrogate the hypothalamic-pituitary-adrenal axis in patients with suspected hypopituitarism?
|
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Published in |
BMC Endocrine Disorders, June 2016
|
DOI | 10.1186/s12902-016-0117-7 |
Pubmed ID | |
Authors |
Aoife Garrahy, Amar Agha |
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. |
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Demographic breakdown
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Members of the public | 4 | 80% |
Science communicators (journalists, bloggers, editors) | 1 | 20% |
Mendeley readers
Geographical breakdown
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Researcher | 5 | 14% |
Student > Ph. D. Student | 4 | 11% |
Student > Doctoral Student | 3 | 8% |
Student > Postgraduate | 3 | 8% |
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Neuroscience | 2 | 6% |
Other | 3 | 8% |
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