Davies M J, Howlett T A
Department of Endocrinology, Leicester Royal Infirmary, England.
J R Soc Med. 1996 Mar;89(3):159P-64P. doi: 10.1177/014107689608900313.
A national survey of the current methods used by specialists to evaluate pituitary function in the UK was performed by postal questionnaire. Seventy-three respondents, of whom 89% were consultants and 80% clinical endocrinologists, returned the questionnaire. Fifty per cent routinely used the insulin stress test (IST) to evaluate the hypothalamo-pituitary-adrenal (HPA) axis, while 50% routinely used tetracosactrin stimulation, there being little overlap between the two groups. This represents a significant change in clinical practice since the last survey in 1988. In those who used ACTH stimulation there was almost an equal split into those who administered the tetracosactrin intramuscularly (45%) or intravenously (47%). Furthermore, either the peak or 60 min cortisol value was used by 71% when interpreting the result of the test, despite the fact that in previous studies only the 30 min cortisol value has been shown to correlate with the IST result. The IST remains the most frequently used method to assess growth hormone reserve in adult subjects. The thyrotrophin-releasing-hormone and gonadotrophin-releasing-hormone tests are still used routinely by approximately a quarter of clinicians. These results provide data that could be used to develop guide-lines for the use of tests to investigate pituitary function.
通过邮政问卷调查对英国专家目前用于评估垂体功能的方法进行了一项全国性调查。73名受访者回复了问卷，其中89%是顾问医生，80%是临床内分泌学家。50%的人常规使用胰岛素耐量试验（IST）来评估下丘脑 - 垂体 - 肾上腺（HPA）轴，而50%的人常规使用二十四肽促皮质素刺激试验，两组之间几乎没有重叠。自1988年上次调查以来，这代表了临床实践中的重大变化。在使用促肾上腺皮质激素（ACTH）刺激试验的人中，几乎平均分为肌肉注射二十四肽促皮质素的人（45%）和静脉注射的人（47%）。此外，在解释试验结果时，71%的人使用峰值或60分钟皮质醇值，尽管在先前的研究中只有30分钟皮质醇值被证明与IST结果相关。IST仍然是评估成年受试者生长激素储备最常用的方法。约四分之一的临床医生仍常规使用促甲状腺激素释放激素和促性腺激素释放激素试验。这些结果提供的数据可用于制定调查垂体功能试验使用的指南。
