{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T07:48:59Z","timestamp":1773301739397,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The insulin tolerance test (ITT) is the gold standard for the diagnosis of GH deficiency (GHD) and hypocortisolism. As hypopituitarism is a common disorder after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH), the test is increasingly used in patients with pre-existing brain damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A cross-sectional, observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty-six patients (41 TBI and 15 SAH) were tested with the ITT (0.15\u200aIE\/kg body weight, mean glucose 33\u200amg\/dl). In 38 patients, the test was performed in a supine position; the other 18 patients were in a sitting position during the ITT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Hypocortisolism and GHD were more often diagnosed in a supine than in a sitting position (hypocortisolism: 55.3% supine versus 0% sitting, <jats:italic>P<\/jats:italic>&lt;0.0001; GHD: 42.1% supine versus 11.1% sitting, <jats:italic>P<\/jats:italic>=0.03). Patients in a sitting position suffered more often from symptoms such as tachycardia (61.1% sitting versus 15.8% supine, <jats:italic>P<\/jats:italic>=0.001), trembling (22.2 vs 7.9%, NS), and sweating (66.7 vs 28.9%, <jats:italic>P<\/jats:italic>=0.007). There were no significant differences between the groups in drowsiness (72.2% sitting versus 65.8% supine, NS), dizziness (44.4 vs 44.7%, NS), and fatigue (33.3 vs 15.8%, NS). Because of somnolence, the hypoglycemic state could only be stopped with i.v. administration of glucose in 25 supine patients (66%). In contrast, none of the 18 patients (0%) tested in a sitting position got somnolent or was in need of i.v. application of glucose (<jats:italic>P<\/jats:italic>&lt;0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with brain injury, posture might affect rates of diagnosing GHD and hypocortisolism and sympathetic symptoms in the ITT. These findings are exploratory and need replication in a standardized setting.<\/jats:p><\/jats:sec>","DOI":"10.1530\/eje-10-0821","type":"journal-article","created":{"date-parts":[[2010,10,28]],"date-time":"2010-10-28T02:32:03Z","timestamp":1288233123000},"page":"31-36","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":3,"title":["Differences in the insulin tolerance test in patients with brain damage depending on posture"],"prefix":"10.1093","volume":"164","author":[{"given":"A","family":"Kopczak","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F","family":"von Rosen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Krewer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H J","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G K","family":"Stalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","reference":[{"issue":"9571","key":"1_28501152","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1016\/S0140-6736(07)60673-4","volume":"369","author":"Schneider","year":"2007","journal-title":"Lancet","ISSN":"https:\/\/id.crossref.org\/issn\/0140-6736","issn-type":"print"},{"key":"2_38817229","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1055\/s-0029-1225611","volume":"118","year":"2010","journal-title":"EXPERIMENTAL AND CLINICAL ENDOCRINOLOGY AND DIABETES"},{"issue":"12","key":"3_29459145","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1001\/jama.298.12.1429","volume":"298","author":"Schneider","year":"2007","journal-title":"JAMA","ISSN":"https:\/\/id.crossref.org\/issn\/0098-7484","issn-type":"print"},{"issue":"2","key":"4_21547643","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1530\/eje.1.02071","volume":"154","author":"Schneider","year":"2006","journal-title":"European Journal of Endocrinology","ISSN":"https:\/\/id.crossref.org\/issn\/0804-4643","issn-type":"print"},{"issue":"6","key":"5_21714151","doi-asserted-by":"publisher","first-page":"2105","DOI":"10.1210\/jc.2005-2476","volume":"91","year":"2006","journal-title":"Journal of Clinical Endocrinology &amp; 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