An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year

Jones, S. L.; Trainer, P. J.; Perry, L.; Wass, J. A. H.; Besser, G. M.; Grossman, A.

doi:10.1111/j.1365-2265.1994.tb03793.x

Cited by 160Adrenal Hormones and DisordersClinical Laboratory Practices and Quality ControlPituitary Gland Disorders and Treatments

An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year

Jones, S. L., Trainer, P. J., Perry, L., Wass, J. A. H., Besser, G. M., Grossman, A.·1994·Clinical Endocrinology

DOI 10.1111/j.1365-2265.1994.tb03793.x

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Abstract

Objective We audited our practice of insulin tolerance testing (ITT) in terms of safety and technical success. We reviewed the results of those tests performed over a 12-month period. By relating peak cortisol response to 0900 h screening cortisol level, we determined whether we could reduce the number of tests performed. Design The results of all ITTs performed on our unit between 1 January and 31 December 1991 were reviewed. Patients and measurements Patients were prescreened by measurement of serum cortisol and thyroxine, and recording of an electrocardiogram. A subnormal serum thyroxine ( Results A total of 161 tests were performed, 135 of which fulfilled our inclusion criteria. The test was technically successful in all but 5 of these; a significant adverse event occurred in one patient with full recovery after reversal of hypoglycaemia. Thirty-two patients had a suboptimal serum cortisol response to hypoglycaemia: screening cortisol level ranged from 128 to 493 nmol/l and 0900 h serum cortisol measured prior to the ITT from 97 to 431 nmol/l. The lowest level of screening cortisol above which all patients would be expected to achieve the normal peak cortisol of 580 nmol/l or over is therefore 494 nmol/l. If this cut-off level had been adopted, 10 (8%) ITTs need not have been performed if their only purpose had been to assess cortisol reserve. Altering the criterion for the necessary peak cortisol to 500 nmol/l did not affect the number of ITTs required. Our lower limit f…

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Most primary reports detailing the 140 nmol/L cutoff value are not based on subjects with PAI.
“Unfortunately, most of the primary reports detailing this cutoff value are not based on subjects with PAI (23,24,(61)(62)(63)(64).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [63]

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Self-citation

Authors: Jones, S. L., Trainer, P. J., Perry, L., Wass, J. A. H., Besser, G. M., & Grossman, A.
Affiliations: St Bartholomew's Hospital (GB)
Corresponding author: Grossman, A.
ORCID: Trainer, P. J.
Wass, J. A. H.
Grossman, A.
Venue: Clinical Endocrinology
Publisher: Wiley
Published: 1994-07
Volume: 41
Issue: 1
Pages: 123-128
ISSN: 0300-0664 (ISSN-L)
1365-2265
DOI: 10.1111/j.1365-2265.1994.tb03793.x
OpenAlex: W1994824546
Cited by: 159
References: 17
Citations by year: 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 2 · 2017: 5 · 2016: 6 · 2015: 7 · 2014: 4 · 2013: 3 · 2012: 3
FWCI: 0.88
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5008 d)
Locations: Clinical Endocrinology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
Keywords: insulin tolerance test, hypoglycemia, growth hormone response, test safety, test reduction, hypopituitarism, adult patients, adverse events
MeSH terms: Acromegaly, Adenoma, Adolescent, Adult, Female, Humans, Hydrocortisone, Insulin, Male, Medical Audit, Middle Aged, Pituitary Diseases, Pituitary Neoplasms, Pituitary-Adrenal Function Tests, Retrospective Studies, Prolactinoma

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An audit of the insulin tolerance test in adult subjects in an acute investigation unit over one year

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