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Funktionsdiagnostik in der Endokrinologie

Functional diagnostics in endocrinology

  • Schwerpunkt: Funktionsdiagnostik in der Inneren Medizin
  • Published:
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Zusammenfassung

Bei der Abklärung vieler endokrinologischer Krankheitsbilder reichen basale Laborparameter nicht aus, um zwischen einer physiologischen und pathologischen Hormonsekretion zu unterscheiden. In diesem Zusammenhang kommt der Funktionsdiagnostik eine entscheidende Rolle zu. Je nachdem ob Unter- oder Überfunktionszustände abgeklärt werden sollen, kommen Stimulations- bzw. Suppressionstests zur Anwendung. In diesem Übersichtsbeitrag sollen ausgewählte Funktionstests besprochen werden, die in aktuellen Leitlinien jeweils einen gesicherten Stellenwert einnehmen. Dabei wird auf Indikationen, Testprinzip und -durchführung, Aussagekraft und Limitationen eingegangen. Thematisiert werden unter anderem der ACTH-Stimulationstest zur Abklärung einer Nebennierenrindeninsuffizienz und der Dexamethasonhemmtest bei Verdacht auf ein Cushing-Syndrom, zudem Funktionstests zur Abklärung von primärem Hyperaldosteronismus, Phäochromozytom, Akromegalie, Wachstumshormonmangel, Schilddrüsenknoten und V.a. medulläres Schilddrüsenkarzinom, Insulinom und Zollinger-Ellison-Syndrom. Explizit nicht empfohlene Funktionstests werden ebenfalls angesprochen.

Abstract

When investigating many endocrinological diseases, basal laboratory parameters are not sufficient to distinguish between physiological and pathological hormone secretion. Functional diagnostics plays a decisive role in this context. Stimulation and suppression tests are used depending on whether under- or over-function needs to be diagnosed. This review article discusses selected functional tests, each of which plays an important role in current guidelines. Indications and test principles, including their performance, reliability, and limitations, are discussed. Topics covered include the ACTH stimulation test for the diagnosis of adrenal cortex insufficiency and the dexamethasone inhibition test for suspected Cushing’s syndrome, as well as functional tests for the diagnosis of primary hyperaldosteronism, pheochromocytoma, acromegaly, growth hormone deficiency, thyroid nodules and suspicion of medullary thyroid carcinoma, insulinoma, and Zollinger-Ellison syndrome. Functional tests that are explicitly not recommended are also addressed.

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  1. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland

    C. J. Auernhammer

  2. Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Campus Innenstadt, Ziemssenstraße 1, 80366, München, Deutschland

    M. Reincke

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Auernhammer, C.J., Reincke, M. Funktionsdiagnostik in der Endokrinologie. Internist 59, 38–47 (2018). https://doi.org/10.1007/s00108-017-0360-7

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