title: Recovery of pituitary function in the late-postoperative phase after pituitary surgery: results of dynamic testing in patients with pituitary disease by insulin tolerance test 3 and 12 months after surgery.
abstract: The insulin tolerance test (ITT) is considered the gold standard for assessment of GH and ACTH reserve in patients with pituitary disease following pituitary surgery and is usually performed after 6-12 weeks. However, abnormal axes may not be completely recovered by then. The aim of this study was to evaluate dynamic testing 3 and 12 months after transsphenoidal pituitary surgery.
  
  
  METHODS
  Serial dynamic testing was performed in 36 patients (13 women, age 18-78) at 3 and 12 months after transsphenoidal surgery.
  
  
  RESULTS
  Compared with 3-month results, median GH peak levels during ITT after 12 months increased by 38% (P<0.05). In patients initially classified as GH deficiency (GHD), median GH peak increased after 12 months by 23% (P<0.05). At 3 and 12 months, 36% (13/36) and 47% (17/36) were GH sufficient respectively. Median cortisol peak levels after 12 months increased by 17% (P<0.01) compared with 3-month ITT. In ACTH-insufficient (AI) patients, peak cortisol levels increased significantly by 12% (P<0.05) at 12 months, and in ACTH-sufficient patients, peak cortisol levels increased significantly by 13% (P<0.05). At 12 months, there was recovery from AI in 11% of the patients, and recovery from GHD in 11% of patients.
  
  
  CONCLUSIONS
  Serial dynamic testing results in a change in classification by ITT results in a relevant proportion of patients. Dynamic testing should be repeated during follow-up.
authors.affiliation: Department of Endocrinology, Division of Laboratory Research, University of Duisburg-Essen, Essen, Germany. christian.berg@uni-due.de
authors.forename: C
authors.initials: C
authors.lastname: Berg
authors.forename: T
authors.initials: T
authors.lastname: Meinel
authors.forename: H
authors.initials: H
authors.lastname: Lahner
authors.forename: K
authors.initials: K
authors.lastname: Mann
authors.forename: S
authors.initials: S
authors.lastname: Petersenn
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000502:physiology; D008875:Middle Aged; D010900:Pituitary Diseases / Q000503:physiopathology / Q000601:surgery*; D010902:Pituitary Gland / Q000502:physiology* / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D007328:Insulin; D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone