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

• Published in: Endocrine Journal Vol. 64; no. 4; pp. 387 - 392
• Main Authors: Nakamura, Akinobu, Kameda, Hiraku, Nagai, So, Shimizu, Chikara, Miyoshi, Hideaki, Atsumi, Tatsuya, Nomoto, Hiroshi, Terauchi, Yasuo, Taguri, Masataka, Cho, Kyu Yong, Takahashi, Kiyohiko
• Format: Journal Article
• Language: English
• Published: Japan The Japan Endocrine Society 2017; Japan Science and Technology Agency
• Subjects: Adult; Asian Continental Ancestry Group; Blood glucose; Blood Glucose - analysis; Blood Pressure; Diagnostic Techniques, Endocrine; Female; Glucose; Homeostasis; Homeostasis model assessment of insulin resistance; Humans; Hypoglycemia; Hypoglycemia - diagnosis; Hypoglycemia - etiology; Hypoglycemia - metabolism; Hypoglycemia - physiopathology; Hypopituitarism; Hypopituitarism - complications; Hypopituitarism - diagnosis; Hypopituitarism - metabolism; Hypopituitarism - physiopathology; Insulin; Insulin Resistance; Insulin tolerance test; Japan; Male; Middle Aged; Pituitary; Pituitary hormones; Retrospective Studies; Risk Factors; Insulin tolerance test; Hypopituitarism; Insulin; Homeostasis model assessment of insulin resistance
• ISSN: 0918-8959; 1348-4540
• DOI: 10.1507/endocrj.EJ16-0332

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.