Document Detail

Differences in the insulin tolerance test in patients with brain damage depending on posture.
MedLine Citation:
PMID:  20980438     Owner:  NLM     Status:  MEDLINE    
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.
A Kopczak; F von Rosen; C Krewer; H J Schneider; G K Stalla; M Schneider
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-27
Journal Detail:
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:
Created Date:  2010-12-14     Completed Date:  2011-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  England    
Other Details:
Languages:  eng     Pagination:  31-6     Citation Subset:  IM    
Schön Klinik Bad Aibling, Kolbermoorer Straße 72, 83043 Bad Aibling, Germany.
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MeSH Terms
Blood Glucose / metabolism
Brain Injuries / blood*
Human Growth Hormone / deficiency
Hydrocortisone / blood
Hypoglycemic Agents / blood*
Insulin / blood*
Insulin Resistance*
Insulin-Like Growth Factor I / metabolism
Middle Aged
Subarachnoid Hemorrhage / blood*
Supine Position
Reg. No./Substance:
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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