Morente C, Kletzky O A
Am J Obstet Gynecol. 1984 Feb 15;148(4):375-80. doi: 10.1016/0002-9378(84)90710-5.
The insulin-induced hypoglycemia test was used to study the hypothalamic-pituitary function of nine normal control subjects and 49 patients with amenorrhea. There were 10 patients with secondary amenorrhea due to hypothalamic dysfunction, eight with hypothalamic failure, eight with primary amenorrhea due to hypogonadotropic hypogonadism, 19 with a prolactin-secreting pituitary adenoma, and four with Sheehan's syndrome. After the administration of insulin (0.15 unit/kg), a significant increase in plasma levels of prolactin, growth hormone, and cortisol occurred in all normal subjects. Of the 10 patients with hypothalamic dysfunction, two had a blunted prolactin response, six had an abnormal growth hormone response, and all had a normal cortisol response. Of those with hypothalamic failure, abnormal responses for prolactin were seen in two patients, for growth hormone in four patients, and all had a normal increase in cortisol. Five of the eight patients with primary amenorrhea had a blunted response for prolactin, six for growth hormone, and there were no abnormalities for plasma cortisol. All 19 patients with pituitary adenomas had a blunted increase in prolactin, 16 had an abnormal growth hormone response, and two had an abnormal cortisol response. Prolactin, growth hormone, and cortisol responses were blunted in all patients with Sheehan's syndrome. These results demonstrate that the release of growth hormone subsequent to insulin-induced hypoglycemia is the most common abnormality seen in women with amenorrhea. The high frequency of abnormal release of prolactin indicates that serum prolactin should be measured when this test is performed. In addition, patients with prolactin-secreting adenomas and those with Sheehan's syndrome should be given an insulin tolerance test before treatment is instituted, so that patients with secondary adrenal insufficiency can be identified.
采用胰岛素诱发低血糖试验研究了9名正常对照者和49例闭经患者的下丘脑 - 垂体功能。其中有10例因下丘脑功能障碍导致继发性闭经，8例下丘脑功能衰竭，8例因低促性腺激素性性腺功能减退导致原发性闭经，19例患有分泌催乳素的垂体腺瘤，4例患有席汉综合征。给予胰岛素（0.15单位/千克）后，所有正常受试者的血浆催乳素、生长激素和皮质醇水平均显著升高。在10例下丘脑功能障碍患者中，2例催乳素反应迟钝，6例生长激素反应异常，所有患者的皮质醇反应正常。在下丘脑功能衰竭患者中，2例催乳素反应异常，4例生长激素反应异常，所有患者的皮质醇均正常升高。8例原发性闭经患者中有5例催乳素反应迟钝，6例生长激素反应迟钝，血浆皮质醇无异常。所有19例垂体腺瘤患者的催乳素升高均迟钝，16例生长激素反应异常，2例皮质醇反应异常。所有席汉综合征患者的催乳素、生长激素和皮质醇反应均迟钝。这些结果表明，胰岛素诱发低血糖后生长激素的释放是闭经女性中最常见的异常情况。催乳素异常释放的高频率表明在进行该试验时应检测血清催乳素。此外，对于分泌催乳素的腺瘤患者和席汉综合征患者，在开始治疗前应进行胰岛素耐量试验，以便识别继发性肾上腺功能不全的患者。
