UTILIDADE DO TESTE DO GLUCAGON NO DIAGNÓSTICO DAS DEFICIÊNCIAS DE GH E CORTISOL EM PEQUENAS LESÕES HIPOFISÁRIAS.

• Ano de defesa: 2018
• Autor(a) principal: ROCHA, Viviane Chaves de Carvalho
• Orientador(a): FARIA, Manuel dos Santos
• Banca de defesa: FARIA, Manuel dos Santos , FURTADO NETO, João Francisco , BECKMAN, Adriana Maria Guimarães Sá , SILVA, Marcelo Magalhães , BRITO, Luciane Maria Oliveira
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Maranhão
• Programa de Pós-Graduação: PROGRAMA DE PÓS-GRADUAÇÃO EM SAÚDE DO ADULTO E DA CRIANÇA/CCBS
• Departamento: DEPARTAMENTO DE MEDICINA I/CCBS
• País: Brasil
• Palavras-chave em Português: Microprolactinomas; Microadenomas Não-Funcionantes; Teste de Estímulo com Glucagon; Dose Fixa; Teste de Tolerância à Insulina; Deficiência de GH; Deficiência de Cortisol
• Palavras-chave em Inglês: Microprolactinomas; Nonfunctioning microadenomas; Glucagon stimulation test; Fixed dose; Insulin tolerance test; Growth hormone deficiency; Cortisol deficiency
• Área do conhecimento CNPq: Endocrinologia.
• Link de acesso: https://tedebc.ufma.br/jspui/handle/tede/2338

The consensus in the literature is that the hypothalamic–pituitary axis should be investigated with stimulus tests only for pituitary lesions larger than 1 cm. Pituitary tumors smaller than 1 cm may present deficiencies of growth hormone and cortisol to the stimulus tests. We evaluated the response of growth hormone and cortisol to the glucagon test of 3 h duration (fixed dose: 1mg and 1,5mg Glucagon on 90 kg and ≥ 90kg, respectively) in 40 patients with pituitary lesions smaller than 1 cm, followed by an insulin tolerance test (ITT) to confirm the deficiencies. In the glucagon test, 3.7% (n=1) of the microprolactinomas did not respond to growth hormone (<3 ng/mL) and 77.8% (n= 21) presented cortisol values >18 μg/dL, while 37.5% of the nonfunctioning microadenomas had a sub-growth hormone (GH deficiency). All 40 patients had growth hormone value >1 ng/mL. Deficiencies of growth hormone and cortisol were not confirmed by the ITT in patients who had on Glucagon Test deficiencies . Our findings demonstrate that the glucagon test has a high number of false positive results with higher cutoff values. The glucagon test has been shown to be a safe option when there is a contraindication to the ITT. Stimulus tests should not be routinely indicated for evaluation of the hypothalamic–pituitary axis in cases of lesions smaller than 1 cm, except in cases where there are metabolic or clinical alterations suggestive of such deficiencies or progressive decreases of insulin-like growth factor 1 (IGF-1) and cortisol during routine follow-up of these patients. There is a need for adequate cutoffs for both growth hormone and cortisol.