Таблица.  Лабораторные тесты для оценки функций гипоталамуса-гипофиза. Перевести на русский язык = Translate into Russian Модификация: Gardner D.G., Shoback D.M., Eds. Greenspan's Basic & Clinical Endocrinology. 9th ed., Lange, 2011, 960 p., см.: Физиология человека: Литература. Иллюстрации.
№	Название теста	Метод	Материал выборки	Возможные побочные эффекты. Противопоказания	Интерпретация
1	Rapid ACTH stimulation test (cosyntropin test)	Administer synthetic ACTH (1-24) (cosyntropin), 250 g intravenously or intramuscularly. The test may be performed at any time of the day or night and does not require fasting. The low-dose test is performed in the same manner except that 1 g of synthetic ACTH (1-24) is administered.	Obtain samples for plasma cortisol at 0 and 30 min or at 0 and 60 min.	Rare allergic reactions have been reported.	A normal response is a peak plasma cortisol level > 18-20 g/dL (496-552 nmol/L).
2	Insulin hypoglycemia test	Give nothing by mouth after midnight. Start an intravenous infusion with normal saline solution. Regular insulin is given intravenously in a dose sufficient to cause adequate hypoglycemia (blood glucose <40 mg/dL). The dose is 0.1-0.15 unit/kg (healthy subjects); 0.2-0.3 unit/kg (obese subjects or those with Cushing syndrome or acromegaly); 0.05 unit/kg (patients with suspected hypopituitarism).	Collect blood for glucose determinations every 15 min during the study. Samples of GH and cortisol are obtained at 0, 30, 45, 60, 75, and 90 min.	A physician must be in attendance. Symptomatic hypoglycemia (diaphoresis, headache, tachycardia, weakness) is necessary for adequate stimulation and occurs 20-35 min after insulin is administered in most patients. If severe central nervous system signs or symptoms occur, intravenous glucose (25-50 mL of 50% glucose) should be given immediately; otherwise, the test can be terminated with a meal or with oral glucose. This test is contraindicated in the elderly or in patients with cardiovascular or cerebrovascular disease and seizure disorders.	Symptomatic hypoglycemia and a fall in blood glucose to <40 mg/dL (2.2 mmol/L) will increase GH to a maximal level > 5 ng/mL; some investigators regard an increment of 6 ng/mL (280 pmol/L) as normal. Plasma cortisol should increase to a peak level of at least 18-20 g/dL (496-552 nmol/L).
3	Metyrapone test	Metyrapone is given orally between 11 and 12 pm with a snack to minimize gastrointestinal discomfort. The dose is 30 mg/kg.	Blood for plasma 11-deoxycortisol and cortisol determinations is obtained at 8 am the morning after metyrapone is given.	Gastrointestinal upset may occur. Adrenal insufficiency may occur. Metyrapone should not be used in sick patients or those in whom primary adrenal insufficiency is suspected.	Serum 11-deoxycortisol should increase to > 7 g/dL (0.19 mol/L). Cortisol should be <10 g/dL (0.28 mol/L) in order to ensure adequate inhibition of 11-hydroxylation.
4	GHRH-arginine infusion test	The patient should be fasting after midnight. Give GHRH, 1 g/kg intravenously over 1 min followed by arginine hydrochloride, 0.5 g/kg intravenously, up to a maximum of 30 g over 30 min.	Blood for plasma GH determinations is collected at 0, 30, 60, 90, and 120 min.	Mild flushing, a metallic taste, or nausea and vomiting may occur. This test is contraindicated in patients with severe liver disease, renal disease, or acidosis.	The lower limit of normal for the peak GH response is 6 ng/mL (280 pmol/L) although most normals reach levels of > 10-15 ng/mL (460-700 pmol/L).
5	Glucagon stimulation test	The patient should be fasting after midnight. Give glucagon 1 mg intramuscularly.	Blood for plasma GH and capillary blood glucose at 0, 30, 60, 90, 120, 150, and 180 min.	Nausea and late hypoglycemia. This test is contraindicated in malnourished patients or patients who have not eaten for > 48 h.	GH rises to > 3 g/L in normal individuals. Glucose usually rises to peak around 90 min, then gradually declines.
6	Glucose growth hormone suppression test	The patient should be fasting after midnight; give glucose, 75-100 g orally.	GH and glucose should be determined at 0, 30, and 60 min after glucose administration.	Patients may complain of nausea after the large glucose load.	GH levels are suppressed to <2 ng/mL (90 pmol/L) in healthy subjects. Failure of adequate suppression or a paradoxic rise may be seen in acromegaly, starvation, protein-calorie malnutrition, and anorexia nervosa.
7	TRH test	Fasting is not required, but since nausea may occur, it is preferred. Give protirelin, 500 g intravenously over 15-30 s. The patient should be kept supine, since slight hypertension or hypotension may occur. Protirelin is supplied in vials of 500 g, although 400 g will evoke normal responses.	Blood for determination of plasma TSH and PRL is obtained at 0, 30, and 60 min. An abbreviated test utilizes samples taken at 0 and 30 min only. A maximum TSH response takes 45 min or less.	No serious complications have been reported. Most patients complain of a sensation of urinary urgency and a metallic taste in the mouth; other symptoms include flushing, palpitations, and nausea. These symptoms occur within 1-2 min of the injection and last 5 min at most.	Normal TSH response: 6 U/mL (6 mU/L) in women and men aged <49 2 U/mL( 2 mU/L) in men aged 40-79 Normal PRL response varies with gender and age.
8	GnRH test	The patient should be at rest but need not be fasting. Give GnRH (gonadorelin), 100 g intravenously, over 15 s.	Blood samples for LH and FSH determinations are taken at 0, 30, and 60 min. Since the FSH response is somewhat delayed, a 90-min specimen may be necessary.	Side effects are rare, and no contraindications have been reported.	This response is dependent on sex and the time of the menstrual cycle. Table 4–9 illustrates the mean maximal change in LH and FSH after GnRH administration. An increase of LH of 1.3-2.6 g/L (12-23 IU/L) is considered to be normal; FSH usually responds more slowly and less markedly. FSH may not increase even in healthy subjects.
9	Clomiphene test	Clomiphene is administered orally. For women, give 100 mg daily for 5 d (beginning on day 5 of the cycle if the patient is menstruating); for men, give 100 mg daily for 7-10 d.	Blood for LH and FSH determinations is drawn before and after clomiphene is given.	This drug may stimulate ovulation, and women should be advised accordingly.	In women, LH and FSH levels peak on the fifth day to a level above the normal range. After the fifth day, LH and FSH levels decline. In men, LH should double after 1 wk; FSH will also increase, but to a lesser extent.
10	CRH test	CRH (1 g/kg) is given intravenously as a bolus injection.	Blood samples for ACTH and cortisol are taken at 0, 15, 30, and 60 min.	Flushing often occurs. Transient tachycardia and hypotension have also been reported.	The ACTH response is dependent on the assay utilized and occurs 15 min after CRH is administered. The peak cortisol response occurs at 30-60 min and is usually > 10 g/dL (276 nmol/L).
11	Low-dose dexamethasone suppression test	Dexamethasone (1 mg) is given between 11 pm and midnight.	Blood samples for cortisol and dexamethasone are taken at 8 am the next morning.	Side effects are rare. Compliance is sometimes an issue. Some medications and patient variability can affect dexamethasone metabolism.	Cortisol should suppress to <1.8 g/dL in normal individuals. This cutoff has a high sensitivity, but specificity is compromised.
Примечание:
Endocrinologic Evaluation of the Hypothalamic-Pituitary Axis The precise assessment of the hypothalamic-pituitary axis has been made possible by radioimmunoassays of the major anterior pituitary hormones and their specific target gland hormones. In addition, provocative testing using synthetic or purified hormones (eg, ACTH, ovine CRH, glucagon, insulin) can be used to assess hypothalamic-pituitary reserve and excess. This section describes the principles involved in testing each pituitary hormone as well as special situations (eg, drugs, obesity) that may interfere with pituitary function or pituitary testing. Specific protocols for performing and interpreting diagnostic procedures are outlined at the end of this section and in Table 4–9. The clinical manifestations of either hypo- or hypersecretion of anterior pituitary hormones are discussed in subsequent sections.