| Differences in the insulin tolerance test in patients with brain damage depending on posture. | |
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MedLine Citation:
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PMID: 20980438 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The insulin tolerance test (ITT) is the gold standard for the diagnosis of GH deficiency (GHD) and hypocortisolism. As hypopituitarism is a common disorder after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), the test is increasingly used in patients with pre-existing brain damage. DESIGN: A cross-sectional, observational study. METHODS: Fifty-six patients (41 TBI and 15 SAH) were tested with the ITT (0.15 IE/kg body weight, mean glucose 33 mg/dl). In 38 patients, the test was performed in a supine position; the other 18 patients were in a sitting position during the ITT. RESULTS: Hypocortisolism and GHD were more often diagnosed in a supine than in a sitting position (hypocortisolism: 55.3% supine versus 0% sitting, P<0.0001; GHD: 42.1% supine versus 11.1% sitting, P=0.03). Patients in a sitting position suffered more often from symptoms such as tachycardia (61.1% sitting versus 15.8% supine, P=0.001), trembling (22.2 vs 7.9%, NS), and sweating (66.7 vs 28.9%, P=0.007). There were no significant differences between the groups in drowsiness (72.2% sitting versus 65.8% supine, NS), dizziness (44.4 vs 44.7%, NS), and fatigue (33.3 vs 15.8%, NS). Because of somnolence, the hypoglycemic state could only be stopped with i.v. administration of glucose in 25 supine patients (66%). In contrast, none of the 18 patients (0%) tested in a sitting position got somnolent or was in need of i.v. application of glucose (P<0.001). CONCLUSIONS: In patients with brain injury, posture might affect rates of diagnosing GHD and hypocortisolism and sympathetic symptoms in the ITT. These findings are exploratory and need replication in a standardized setting. |
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Authors:
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A Kopczak; F von Rosen; C Krewer; H J Schneider; G K Stalla; M Schneider |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-10-27 |
Journal Detail:
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Title: European journal of endocrinology / European Federation of Endocrine Societies Volume: 164 ISSN: 1479-683X ISO Abbreviation: Eur. J. Endocrinol. Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2010-12-14 Completed Date: 2011-01-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9423848 Medline TA: Eur J Endocrinol Country: England |
Other Details:
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Languages: eng Pagination: 31-6 Citation Subset: IM |
Affiliation:
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Schön Klinik Bad Aibling, Kolbermoorer Straße 72, 83043 Bad Aibling, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Blood Glucose / metabolism Brain Injuries / blood* Female Human Growth Hormone / deficiency Humans Hydrocortisone / blood Hypoglycemic Agents / blood* Insulin / blood* Insulin Resistance* Insulin-Like Growth Factor I / metabolism Luminescence Male Middle Aged Posture* Subarachnoid Hemorrhage / blood* Supine Position |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Hypoglycemic Agents; 11061-68-0/Insulin; 12629-01-5/Human Growth Hormone; 50-23-7/Hydrocortisone; 67763-96-6/Insulin-Like Growth Factor I |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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