{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T04:23:51Z","timestamp":1750739031372},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"1","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":["eur j endocrinol"],"published-print":{"date-parts":[[2006,1]]},"abstract":"<jats:p><jats:italic>Objective<\/jats:italic>: The aim of this study was to review the results of dynamic pituitary testing in patients presenting with fatigue.<\/jats:p><jats:p><jats:italic>Methods<\/jats:italic>: We reviewed clinical histories and insulin tolerance test (ITT) results of 59 patients who presented with fatigue and other symptoms of glucocorticoid insufficiency over a 4-year period. All patients referred for ITT had an early-morning cortisol level of &lt;400 nM and a low or normal ACTH level.<\/jats:p><jats:p><jats:italic>Results<\/jats:italic>: Peak cortisol and GH responses following insulin-induced hypoglycaemia were normal in only seven patients (12%). Median age of the remaining 52 patients was 47 years (range, 17\u201367 years); all but five were female. Common presenting symptoms were neuroglycopaenia (<jats:italic>n<\/jats:italic>= 47), depression (<jats:italic>n<\/jats:italic>= 37), arthralgia and myalgia (<jats:italic>n<\/jats:italic>= 28), weight gain (<jats:italic>n<\/jats:italic>= 25), weight loss (<jats:italic>n<\/jats:italic>= 9), postural dizziness (<jats:italic>n<\/jats:italic>= 15) and headaches (<jats:italic>n<\/jats:italic>= 13). Other medical history included autoimmune disease (<jats:italic>n<\/jats:italic>= 20; particularly Hashimoto\u2019s thyroiditis, Graves\u2019 disease and coeliac disease), postpartum (<jats:italic>n<\/jats:italic>= 8) and gastrointestinal (<jats:italic>n<\/jats:italic>= 2) haemorrhage and hyperprolactinaemia (<jats:italic>n<\/jats:italic>= 13). 31 subjects had peak cortisol levels of &lt;500 nM (suggestive of ACTH deficiency; 18 of whom had levels &lt; 400 nM) and a further six had indeterminate results (500\u2013550 nM). The remaining 15 subjects had normal cortisol responses (median 654 nM; range, 553\u20131062 nM) but had low GH levels following hypoglycaemic stimulation (5.9 mU\/l; 3\u201311.6 mU\/l).<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Our results suggest that patients presenting with fatigue and symptoms suggestive of hypocortisolism should be considered for screening for secondary adrenal insufficiency, particularly in the presence of autoimmune disease or a history of postpartum or gastrointestinal haemorrhage. Whether physiological glucocorticoid replacement improves symptoms in this patient group is yet to be established.<\/jats:p>","DOI":"10.1530\/eje.1.02010","type":"journal-article","created":{"date-parts":[[2005,12,28]],"date-time":"2005-12-28T18:33:21Z","timestamp":1135794801000},"page":"147-157","update-policy":"http:\/\/dx.doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of pituitary function in the fatigued patient: a review of 59 cases"],"prefix":"10.1093","volume":"154","author":[{"given":"Jerry R","family":"Greenfield","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Samaras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","reference":[{"issue":"9372","key":"1_17660455","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1016\/S0140-6736(03)13492-7","volume":"361","author":"Arlt","year":"2003","journal-title":"Lancet","ISSN":"http:\/\/id.crossref.org\/issn\/0140-6736","issn-type":"print"},{"key":"2_28590663","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1046\/j.1365-2265.1998.00611.x","volume":"49","year":"1998","journal-title":"CLINICAL ENDOCRINOLOGY OXFORD"},{"issue":"5","key":"3_5981729","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1159\/000023179","volume":"49","author":"de Luis","year":"1998","journal-title":"Hormone research","ISSN":"http:\/\/id.crossref.org\/issn\/0301-0163","issn-type":"print"},{"key":"4_28590664","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1365-2265.1991.tb03524.x","volume":"35","year":"1991","journal-title":"CLINICAL ENDOCRINOLOGY OXFORD"},{"issue":"1","key":"5_8586253","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00005792-198201000-00002","volume":"61","author":"Stacpoole","year":"1982","journal-title":"Medicine","ISSN":"http:\/\/id.crossref.org\/issn\/0025-7974","issn-type":"print"},{"issue":"1","key":"6_18073914","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1507\/endocrj.51.115","volume":"51","author":"Miyauchi","year":"2004","journal-title":"Endocrine journal","ISSN":"http:\/\/id.crossref.org\/issn\/0918-8959","issn-type":"print"},{"issue":"3","key":"7_21562139","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1507\/endocrj.51.355","volume":"51","author":"Chikada","year":"2004","journal-title":"Endocrine journal","ISSN":"http:\/\/id.crossref.org\/issn\/0918-8959","issn-type":"print"},{"issue":"6","key":"8_17353188","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1530\/eje.0.1470767","volume":"147","author":"Tanaka","year":"2002","journal-title":"European Journal of Endocrinology","ISSN":"http:\/\/id.crossref.org\/issn\/0804-4643","issn-type":"print"},{"issue":"4","key":"9_10994599","first-page":"327","volume":"150","author":"Beressi","year":"1999","journal-title":"Annales de m&#x00A0;&#x00A0;decine interne","ISSN":"http:\/\/id.crossref.org\/issn\/0003-410X","issn-type":"print"},{"issue":"8","key":"10_15960077","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1210\/jc.80.8.2302","volume":"80","author":"Thodou","year":"1995","journal-title":"Journal of Clinical Endocrinology &amp; 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