ECE2016 Eposter Presentations Neuroendocrinology (43 abstracts)
The hypotalamic-pituitary-adrenal axis changes in non-pituitary brain tumors survives and the best method of its diagnostic
Alla Yudina 1 , Tatiana Tselovalnikova 1 , Maria Pavlova 1 , Nadezhda Mazerkina 2 , Olga Gheludcova 3 , Irina Arefeva 2 , Evgenia Martynova 1 & Anastasia Koklina 1
1First Moscow State Medical University n.a. I.M. Sechenov, Moscow, Russia; 2Burdenko Neurosurgery Institute, Moscow, Russia; 3Russian Scientific Center of Roentgenoradiology, Moscow, Russia.
The number of the non-pituitary brain tumors survives increases and will be growing up in the future. Although the prevalence of secondary adrenal insufficiency (SAI) vary depending on the methods of diagnostic, we have a few data about their ACTH and DHAE-S status. The aim of our study was to describe the hypotalamic-pituitary-adrenal axis (HPAA) changes after craniospinal irradiation (CRT) and diagnostic utility basal cortisol (BC), DHAE-S, glucagon stimulation test (GST) in comparison with the insulin tolerance test (ITT) in this group of patients.
ACTH and cortisol (basal and during ITT), DHAE-S was examined in 31 medulloblastoma survives (15 females), aged Me=19[17;22], 2–15 year after CRT and in 10 normal controls (Me=21 [23;27] year), GST was performed in 19 patients and all healthy. The cut-off point for ITT was 550. After ITT patients was divided into subgroups: SAI and without SAI (W-SAI). Receiver-operating characteristic (ROC) analysis was performed to identify the thresholds for BC, DHAE-S and GST.
16/31 (51.6%) had SAI by ITT. All groups had the same ACTH level. BC was significantly higher in W-SAI patient (Me=559 [374;688]) compare with healthy (Me=363 [214;602] P=0.037) and SAI (Me=353[271;388] P=0.001). SAI-patients had DHAE-S (Me=3.1[2.2;3.9]) lower than W-SAI (Me=4.8[2.6;6.4], P=0.018) and controls (Me=6.4[3.3;8.4], P=0.06), W-SAI and healthy not distinguished (P=0.4) in DHAE-S level.
GST and ITT had the same maximal ACTH and cortisol level (P=0.15 and P=0.6, Wilcoxon test). ROC-analysis showed area under curve (AUC) for GST=0.64 with optimal cut-off for cortisol=580; for BC AUC=0.72 with maximum specificity for cortisol more than 500; for DHAE-S AUC=0.814 with optimal sensitivity/specificity ratio DHAE-S=4.4.
Prevalence of SAI after CRT is high. W-SAI-patients have a tendency to increased BC while SAI-patients have a lower DHEA-S. GST may use as screening stimulation test when ITT is contraindicated while BC and DHAE-S levels in a grey zone.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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