Differences in the insulin tolerance test in patients with brain damage depending on posture.
OBJECTIVE
The insulin tolerance test (ITT) is the gold standard for the diagnosis of GH deficiency (GHD) and hypocortisolism. As hypopituitarism is a common disorder after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), the test is increasingly used in patients with pre-existing brain damage.


METHODS
A cross-sectional, observational study.


METHODS
Fifty-six patients (41 TBI and 15 SAH) were tested with the ITT (0.15 IE/kg body weight, mean glucose 33 mg/dl). In 38 patients, the test was performed in a supine position; the other 18 patients were in a sitting position during the ITT.


RESULTS
Hypocortisolism and GHD were more often diagnosed in a supine than in a sitting position (hypocortisolism: 55.3% supine versus 0% sitting, P<0.0001; GHD: 42.1% supine versus 11.1% sitting, P=0.03). Patients in a sitting position suffered more often from symptoms such as tachycardia (61.1% sitting versus 15.8% supine, P=0.001), trembling (22.2 vs 7.9%, NS), and sweating (66.7 vs 28.9%, P=0.007). There were no significant differences between the groups in drowsiness (72.2% sitting versus 65.8% supine, NS), dizziness (44.4 vs 44.7%, NS), and fatigue (33.3 vs 15.8%, NS). Because of somnolence, the hypoglycemic state could only be stopped with i.v. administration of glucose in 25 supine patients (66%). In contrast, none of the 18 patients (0%) tested in a sitting position got somnolent or was in need of i.v. application of glucose (P<0.001).


CONCLUSIONS
In patients with brain injury, posture might affect rates of diagnosing GHD and hypocortisolism and sympathetic symptoms in the ITT. These findings are exploratory and need replication in a standardized setting.
Kopczak
A
A
Schön Klinik Bad Aibling, Kolbermoorer Straße 72, 83043 Bad Aibling, Germany.
von Rosen
F
F
Krewer
C
C
Schneider
H J
HJ
Stalla
G K
GK
Schneider
M
M
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001930:Brain Injuries / Q000097:blood*; D005260:Female; D019382:Human Growth Hormone / Q000172:deficiency; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007004:Hypoglycemic Agents / Q000097:blood*; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D049449:Luminescence; D008297:Male; D008875:Middle Aged; D011187:Posture; D013345:Subarachnoid Hemorrhage / Q000097:blood*; D016683:Supine Position
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D006854:Hydrocortisone