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14-September-2008 18:02:46 - tolerance test An insulin tolerance test ITT is a medical diagnostic procedure during which insulin is injected into a patient's vein to assess pituitary function, adrenal function, and sometimes for other purposes. An ITT is usually ordered and interpreted by endocrinologists. Insulin injections are intended to induce hypoglycemia. In response, ACTH and Growth Hormone GH are released as a part of the stress mechanism. ACTH elevation causes the adrenal cortex to release cortisol. Normally, both cortisol and GH serve as Counterregulatory hormones, opposing the action of insulin, i.e. acting against the hypoglycemia.1 Thus ITT is considered to be a Gold standard for assessing the integrity of the hypothalamo-pituitary-adrenal axis. Sometimes ITT is performed to assess the peak adrenal capacity, e.g. before surgery. It is assumed that the ability to respond to insulin induced hypoglycemia translates into appropriate cortisol rise in the stressful event of acute illness or major surgery.2 This test is potentially very dangerous and must be undertaken with great care. A health professional must attend it at all times. Contents 1 Side Effects 2 Contraindications 3 Interpretation 3.1 Hypopituitarism 3.2 Cushing's syndrome 4 See also 5 References Side Effects Side effects include sweating, palpitations, loss of consciousness and rarely convulsions due to severe hypoglycemia which may cause coma. If extreme symptoms are present, glucose should be given |intravenously. In subjects with no adrenal reserve an Addisonian crisis may occur. For cortisol stimulation, the ACTH stimulation test has much less risk Contraindications Age 60 years This test should not be performed on children outside a specialist pediatric endocrine unit Ischemic heart disease Epilepsy Severe panhypopituitarism, hypoadrenalism Hypothyroidism impairs the GH and cortisol response. Patients should have corticosteroid replacement commenced prior to thyroxine as the latter has been reported to precipitate an Addisonian crisis with dual deficiency. If adrenal insufficiency is confirmed, the need for a repeat ITT may need to be reconsidered after 3 months thyroxine therapy. Interpretation The test cannot be interpreted unless hypoglycaemia 2.2 mmol/L is achieved. Hypopituitarism An adequate cortisol response is defined as a rise to greater than 550 nmol/L. Patients with impaired cortisol responses greater than 550 but less than 400 nmol/L may only need steroid cover for major illnesses or stresses. An adequate GH response occurs with an absolute response exceeding 20 mU/L. Cushing's syndrome There will be a rise of less than 170 nmol/L above the fluctuations of basal levels of cortisol. See also ACTH stimulation test hypopituitarism triple bolus test References ^ Greenwood FC, Landon J, Stamp TCB 1965. The plasma sugar, free fatty acid, cortisol and growth hormone response to insulin.. J Clin Invest 45: 429-. ^ Plumpton FS, Besser GM. 1969. The adrenocortical response to surgery and insulin-induced hypoglycaemia in corticosteroid-treated and normal subjects. Br J Surg 56: 216-219. This medical article is a stub. Retrieved from http://en..org/wiki/Insulin_tolerance_test Categories: Medicine stubs Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page This page was last modified on 14 July 2008, at 07:25
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