problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl12528problendo-12528Research ArticleДетская эндокринологияPediatric EndocrinologyСравнительное исследование тестов с глюкагоном и инсулином для диагностики вторичного гипокортицизма и дефицита гормона роста у детей и подростковComparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescentshttps://orcid.org/0000-0001-5689-0194ВитебскаяА. В.VitebskayaA. V.

Витебская Алиса Витальевна – кандидат медицинских наук.119881, Москва, ул. Б. Пироговская, д. 19.eLibrary SPIN: 9857-9551

Alisa V. Vitebskaya - MD, PhD.19 B. Pirogovskaya street, 119881 Moscow.eLibrary SPIN: 9857-9551

dr.vitebskaya@mail.ruhttps://orcid.org/0000-0002-4184-2605ПисареваЕ. А.PisarevaE. A.

Писарева Елена Александровна - кандидат медицинских наук.119881, Москва, ул. Б. Пироговская, д. 19.eLibrary SPIN: 7463-2105

Elena A. Pisareva - MD, PhD.19 B. Pirogovskaya street, 119881 Moscow.eLibrary SPIN: 7463-2105

pisarevaea@rambler.ruhttps://orcid.org/0000-0002-9660-8795ПоповичА. В.PopovichA. V.

Попович Анастасия Владимировна.119881, Москва, ул. Б. Пироговская, д. 19.eLibrary SPIN: 3241-4064

Anastaiya V. Popovich – MD.19 B. Pirogovskaya street, 119881 Moscow.eLibrary SPIN: 3241-4064

krutova_nastasya@mail.ruПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation2020301220206665058Copyright © Витебская А.В., Писарева Е.А., Попович А.В., 20202020Витебская А.В., Писарева Е.А., Попович А.В.Vitebskaya A.V., Pisareva E.A., Popovich A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/12528

ОБОСНОВАНИЕ. Диагностика дефицита соматотропного гормона (СТГ) и вторичного гипокортицизма (ВГК) основана на оценке пиков концентрации СТГ и кортизола в провокационных тестах. В Российском консенсусе по диагностике и лечению гипопитуитаризма у детей и подростков рекомендуется определение концентраций СТГ и кортизола в каждой временной точке теста с инсулином (ТИ). Тест с глюкагоном (ТГ) рассматривается в литературе как альтернатива ТИ.ЦЕЛЬ. Оценить возможность применения ТГ для диагностики ВГК и дефицита СТГ у детей и подростков.МАТЕРИАЛЫ И МЕТОДЫ. Проведено исследование кортизола в крови и моче, ТИ и ТГ у 20 пациентов 6,5–17,8 года (Ме 13,0 (10,4; 15,3)), перенесших хирургическое лечение и/или лучевую и/или химиотерапию по поводу объемных образований головы и шеи; ремиссия 0,4–7,5 года (Ме 2,1 (1,5; 5,2)).РЕЗУЛЬТАТЫ. При точке отсечения 550 нмоль/л чувствительность и специфичность ТИ составили 100% и 60%, ТГ — 100% и 53% соответственно. Минимальный уровень точки отсечения кортизола для ТГ при чувствительности 100% — 500 нмоль/л, максимальный при специфичности 100% — 400 нмоль/л.Уровень кортизола в ранние утренние часы был ниже 250 нмоль/л у 2 пациентов с ВГК и выше 500 нмоль/л у 8 пациентов без ВГК при первичном или повторном обследовании.Недостаточность СТГ была подтверждена ТИ у всех пациентов. Максимальные концентрации СТГ в ходе ТГ и ТИ статистически значимо не различались (p>0,05), но результаты ТГ у 4 пациентов превышали или соответствовали пороговым значениям для данного теста (7 нг/мл).Для ТГ характерна меньшая тяжесть состояния по сравнению с ТИ.ЗАКЛЮЧЕНИЕ. В ТГ для диагностики ВГК в качестве точек отсечения могут быть предложены: уровень кортизола 500 (чувствительность 100%, специфичность 53%) и 400 нмоль/л (чувствительность 80%, специфичность 100%). Определение уровня кортизола в 2–3 образцах крови в утреннее время позволяет исключить или заподозрить ВГК у половины пациентов до проведения теста. Пики СТГ в ходе ТГ могут превышать аналогичные показатели в ТИ, что требует дальнейшего изучения.

BACKGROUND

BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation.

 

 

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The authors declare that there are no conflicts of interest present.