Factors associated with an inadequate hypoglycemia in the insulin tolerance test in Japanese patients with suspected or proven hypopituitarism

Kiyohiko Takahashi; Akinobu Nakamura; Hideaki Miyoshi; Hiroshi Nomoto; Hiraku Kameda; Kyu Yong Cho; So Nagai; Chikara Shimizu; Masataka Taguri; Yasuo Terauchi; Tatsuya Atsumi

doi:10.1507/endocrj.EJ16-0332

ORIGINALS

Factors associated with an inadequate hypoglycemia in the insulin tolerance test in Japanese patients with suspected or proven hypopituitarism

Kiyohiko Takahashi, Akinobu Nakamura, Hideaki Miyoshi, Hiroshi Nomoto, Hiraku Kameda, Kyu Yong Cho, So Nagai, Chikara Shimizu, Masataka Taguri, Yasuo Terauchi, Tatsuya Atsumi

Author information

Kiyohiko Takahashi
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Akinobu Nakamura
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Hideaki Miyoshi
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Hiroshi Nomoto
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Hiraku Kameda
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Kyu Yong Cho
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
So Nagai
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Chikara Shimizu
Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
Masataka Taguri
Department of Biostatistics, Yokohama City University, Yokohama, Japan
Yasuo Terauchi
Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
Tatsuya Atsumi
Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

Keywords: Insulin tolerance test, Hypopituitarism, Insulin, Homeostasis model assessment of insulin resistance

JOURNAL FREE ACCESS

2017 Volume 64 Issue 4 Pages 387-392

DOI https://doi.org/10.1507/endocrj.EJ16-0332

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Abstract

We attempted to identify the predictors of an inadequate hypoglycemia in insulin tolerance test (ITT), defined as a blood glucose level higher than 2.8 mmol/L after insulin injection, in Japanese patients with suspected or proven hypopituitarism. A total of 78 patients who had undergone ITT were divided into adequate and inadequate hypoglycemia groups. The relationships between the subjects’ clinical parameters and inadequate hypoglycemia in ITT were analyzed. Stepwise logistic regression analysis identified high systolic blood pressure (SBP) and high homeostasis model assessment of insulin resistance (HOMA-IR) as being independent factors associated with inadequate hypoglycemia in ITT. Receiver operating characteristic (ROC) curve analysis revealed the cutoff value for inadequate hypoglycemia was 109 mmHg for SBP and 1.4 for HOMA-IR. The areas under ROC curve for SBP and HOMA-IR were 0.72 and 0.86, respectively. We confirmed that high values of SBP and HOMA-IR were associated with inadequate hypoglycemia in ITT, regardless of the degree of reduction of pituitary hormone levels. Furthermore, the strongest predictor of inadequate hypoglycemia was obtained by using the cutoff value of HOMA-IR. Our results suggest that HOMA-IR is a useful pre-screening tool for ITT in these populations.

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