Diagnosis for Simmonds disease include glands and anterior pituitary function examination, determination of adrenocortical, thyroid, gonadal, ACTH stimulation test, TSH stimulation test.
Laboratory tests use to diagnosis for Simmonds disease:
1. the around glands function examination:
1) determination of adrenocortical function:
24-hour urine 17 - dione steroids, 17 - hydroxy steroid (17-OHCS) and urinary free cortisol were lower than normal.
ACTH stimulation test: ACTH25μ glucose dissolved in saline 5% glucose 500ml, intravenous infusion, the maintenance of eight hours, the patients with Simmonds disease were delayed reaction, need to be continuous intravenous infusion of 2 to 3 days, urine 17-KS and 17-OHCS gradually increased.
2) determination of thyroid function:
serum T3, T4 and thyroid normal.
TSH stimulation test: TSH 10μ intramuscular injection, one time per day, a total of 3 days. The patients with Simmonds disease can be increased thyroid gland 131 Ⅰ perturbation rate and serum T3, T4, but the response was delayed.
3) determination of gonadal function: Male serum testosterone and urinary 17-KS; in women serum estradiol and urinary estrogens (estrone, estradiol, estriol) levels is lower. Vaginal smear cytology significantly decreased the estrogenic activity.
2. anterior pituitary function examination:
1) serum TSH, LH, FSH, ACTH and GH may be lower than normal.
2) determination of ACTH secretion:
A pyrazole ketone tests: a pyrazole-one for 11-β-hydroxylase inhibitor, can block cortisol synthesis and secretion of anterior pituitary secretion of feedback stimulation ACTH. A one pyrazole 750mg, every 4 hours 1, anterior pituitary dysfunction, the plasma ACTH is not increased.
excited insulin hypoglycemia test: hypoglycemia caused by insulin may stimulate the secretion of anterior pituitary ACTH, GH and PRL. Intravenous insulin 0.1u/kg, 30 minutes after the check blood ACTH. ACTH should be the normal> 200 pmol / L, an average of 300 pmol / L; the disease was lower ACTH response or lack of. In this study, a certain danger of a general caution.
3) determination of growth hormone secretion:
excited insulin hypoglycemia test: the normal response to intravenous insulin peaked at 30 ~ 60 minutes, about 35 ± 20μg / L (35 ± 20ng/ml); pituitary response to reduce disease or no response.
oral L-dopa L-dopa stimulation test 0.5g, taking 60 to 120 minutes, blood GH should be > 7μg / L (7ng/ml).
arginine stimulation test: 5% intravenous infusion of arginine 500ml.
Test Glucagon: Glucagon 1mg, intramuscular injection.
4) determination of prolactin (PRL) secretion:
thyrotropin-releasing hormone (TRH) test: TRH500μg 15 minutes after intravenous injection, blood PRL peak, males can be 3 to 5 times higher for women increased from 6 to 20 times. When Anterior pituitary dysfunction, the basis of the value is low, can not rise after the excitement.
metoclopramide test: oral metoclopramide 10mg, results is same to the TRH test.
insulin hypoglycemia stimulation test: normal blood PRL in intravenous insulin reached a peak after 1 hour, up to 1.6 ~ 2.0nmol / L (40 ~ 50ng/ml), female is higher.
5) determination of gonadotropin (Gn) secretion: intravenous injection of luteinizing hormone-releasing hormone (LHRH) 100μg 15 ~ 30 minutes, LH and FSH in women based on the peak value of more than 3 times, 2 times for males. Non-response or low response prompted for anterior pituitary hypofunction; if peaked at 60 ~ 90 minutes is the delayed response, identify the hypothalamus lesions.
