[The glucagon test in diagnosis of secondary adrenal insufficiency after craniospinal irradiation: the feasibility of application, the features of performing the test, and its diagnostic informativity].

Autor:	Yudina AE; I.M. Sechenov First Moscow State Medical University., Pavlova MG; I.M. Sechenov First Moscow State Medical University., Sotnikov VM; Russian Scientific Center of Roentgeno-Radiology., Tselovalnikova TY; I.M. Sechenov First Moscow State Medical University., Mazerkina NA; N.N. Burdenko National Scientific and Practical Center for Neurosurgery., Zheludkova OG; Russian Scientific Center of Roentgenoradiology., Gerasimov AN; I.M. Sechenov First Moscow State Medical University., Teryaeva NB; N.N. Burdenko National Scientific and Practical Center for Neurosurgery., Martynova E; I.M. Sechenov First Moscow State Medical University., Kim EI; I.M. Sechenov First Moscow State Medical University.
Jazyk:	ruština
Zdroj:	Problemy endokrinologii [Probl Endokrinol (Mosk)] 2019 Dec 25; Vol. 65 (4), pp. 227-235. Date of Electronic Publication: 2019 Dec 25.
DOI:	10.14341/probl10219
Abstrakt:	Background: The glucagon test (GT) is a promising alternative to the insulin hypoglycemia test (IHT) in diagnosis of secondary adrenal insufficiency (SAI). Aim: To study the feasibility of using the GT in patients after craniospinal irradiation and to determine the cut-off value to rule out SAI. Methods: A total of 28 patients (14 males and 14 females) with the median age of 19 years (17; 23) who had undergone combination treatment (surgery, craniospinal irradiation (35 Gy) with boost to the tumor bed, and polychemotherapy) of extrapituitary brain tumors no later than 2 years before study initiation and 10 healthy volunteers of matching sex and age were examined. All the subjects underwent the GT and IHT with an interval of at least 57 days. The cortisol, ACTH, and glucose levels were measured. Results: Twelve out of 28 patients were diagnosed with SAI according to the IHT results. ROC analysis revealed that cortisol release during the GT 499 nmol/L ruled out SAI [100% sensitivity (Se); 62% specificity (Sp)], while the absence of a rise 340 nmol/l verified SAI (Sp 100%; 55% Se). For GT, the area under a curve (AUC) was 93.6%, which corresponds to a very good diagnostic informativity. In 19 patients, the IHT and GT results were concordant (in ten patients, the release of cortisol occurred above the cut-off value in both tests; no release was detected in nine patients). In nine cases, the results were discordant: the maximum cortisol level detected in the GT was 500 nmol/l, but the IHT results ruled out SAI (the GT yielded a false positive outcome). Contrariwise, in three (10.7%) patients the release of cortisol detected in the GT was adequate, while being insufficient in the IHT test. Adverse events (nausea) were reported during the GT test in 9 (25%) subjects; one patient had hypoglycemia (1.8 mmol/l). Conclusion: GT is highly informative and can be used as a first-level stimulation test for ruling out SAI in patients exposed to craniospinal irradiation performed to manage brain tumors. The cortisol level of 500 nmol/L is the best cut-off value for ruling out SAI according to the GT results. The insulin hypoglycemia test is used as the second-level supporting test in patients with positive GT results.
Databáze:	MEDLINE
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