A comparison of pituitary-adrenal responses to corticotropin-releasing hormone, hypoglycaemia and metyrapone in children with brain tumours and growth hormone deficiency

Abstract

To assess hypothalamic-pituitary function, a corticotropin-releasing hormone (CRH) stimulation test was performed in nine children following treatment for brain tumours and in 27 growth hormone deficient (GHD) children whose pituitary adrenocorticotropin (ACTH) secretion was normal. In both groups, CRH tests were compared with ACTH and cortisol responses to insulin-induced hypoglycaemia and with ACTH response to metyrapone stimulation. In the patients with brain tumours (five craniopharyngiomas, two suprasellar germinomas, one cerebellar medulloblastoma and one cerebellar ependymoma), ACTH responses to CRH varied greatly with absent or blunted, normal, and exaggerated reactions. Cortisol and ACTH responses were not always correlated. In GHD children but not in children with brain tumours the responses to CRH, insulin tolerance test and metyrapone test were correlated. The marked variability of the CRH test was possibly caused by compounding factors such as preceding corticosteroid therapy, concomitant desmopressin therapy and spontaneous regeneration of damaged brain structures

Conclusion: Interpretation of the CRH test to assess hypothalamic-pituitary function in patients with brain tumours is difficult due to compounding factors. Many patients require prolonged follow up with repeated endocrinological evaluation.