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Vergleichende Untersuchungen zur Wachstumshormonsekretion bei Akromegalie nach isolierter und kombinierter Anwendung des Insulinhypoglykämie-, LH-RH- und TRH-Tests

Comparative studies of growth hormone secretion in acromegaly after isolated and combined application of insulin hypoglycemia, LH-RH- and TRH tests

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Summary

Growth hormone (GH) release was measured in 17 patients with active acromegaly following the administration of insulin, LH-RH and TRH given intravenously either combined or each separately. The simultaneous application of insulin and the hypothalamic releasing hormones resulted in a striking increase of plasma GH in 15 out of 17 patients. Inappropriate stimulation of GH release was found in 9 out of the 17 patients with acromegaly, when TRH was given as the only hormone; conversely this phenomenon due to LH-RH application was observed in 4 cases. In insulin-induced hypoglycemia GH release could be stimulated in 5 patients.

After selective, transsphenoidal hypophysectomy, 4 of 13 patients still showed a definite stimulation of GH release after the combined use of test substances. Two of these also exhibited a comparable stimulation of GH after TRH, indicating adenoma cells remaining active after operation.

The combined insulin-induced hypoglycemia/LH-RH/TRH-test is therefore advisable for patients with acromegaly, since GH release as well as other hypophyseal partial functions can be tested. The performance of individual tests is essential for evaluating selective stimulation of GH release.

Zusammenfassung

Die Stimulierbarkeit der Wachstumshormon (STH)-Sekretion wurde bei 17 Patienten mit florider Akromegalie sowohl nach zeitlich getrennter als auch nach simultaner intravenöser Gabe von Insulin, LH-RH und TRH untersucht. Bei simultaner Applikation kam es bei 15 der 17 Akromegalen zu ausgeprägten STH-Anstiegen. Die inappropriate Stimulation der STH-Sekretion nach alleiniger TRH-Applikation wurde bei 9 Patienten beobachtet, während diese nach LH-RH in 4 Fällen nachweisbar war. Im isoliert durchgeführten Insulinhypoglykämie-Test erfolgte ein eindeutiger STH-Anstieg bei 5 Patienten.

Nach selektiver, transsphenoidaler Hpophysektomie waren durch die kombinierte Anwendung der Testsubstanzen von 13 Patienten noch 4 deutlich stimulierbar. Zwei von diesen wiesen jedoch auch eine vergleichbare Stimulierbarkeit des STH nach TRH auf, was als Hinweis auf operativ belassene, sekretionsfähige Adenomzellen zu werten ist.

Der kombinierte Insulinhypoglykämie/LH-RH/TRH-Test ist auch bei dem Krankheitsbild der Akromegalie empfehlenswert, da hierdurch simultan außer der WAchstumshormonsekretion auch die übrigen hypophysären Partialfunktionen erfaßt werden können. Bei Fragen zur selektiven Stimulation der STH-Sekretion ist die zeitlich getrennte Durchführung des Tests erforderlich.

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Authors and Affiliations

  1. 2. Medizinische Klinik und Poliklinik der Universität Düsseldorf, Germany

    K. R. Schneider, G. Müller,  W. Wiegelmann, H. G. Solbach & H. L. Krüskemper

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  1. K. R. Schneider
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  2. G. Müller
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  3. W. Wiegelmann
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  4. H. G. Solbach
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  5. H. L. Krüskemper
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Mit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft

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Schneider, K.R., Müller, G., Wiegelmann, W. et al. Vergleichende Untersuchungen zur Wachstumshormonsekretion bei Akromegalie nach isolierter und kombinierter Anwendung des Insulinhypoglykämie-, LH-RH- und TRH-Tests. Klin Wochenschr 56, 461–467 (1978). https://doi.org/10.1007/BF01477061

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