Clinical features and diagnosis of secondary adrenal insufficiency followed complex treatment nonpituitary brain tumors

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  • Authors: Yudina A.E.1, Pavlova M.G.1, Sotnikov V.M.2, Yudina A.E.1, Sych Y.P.1, Mazerkina N.A.3, Zheludkova O.G.4, Teryaeva N.B.4, Gerasimov A.N.1, Martynova E.1, Kim E.I.1, Berkovskaya M.A.1
  • Affiliations:
    1. I.M. Sechenov First Moscow State Medical University (Sechenov University)
    2. Russian Scientific Center of Roentgeno-Radiology
    3. N.N. Burdenko National Scientific and Practical Center for Neurosurgery
    4. Russian Scientific Center of Roentgenoradiology
  • Issue: Vol 65, No 5 (2019)
  • Pages: 330-340
  • Section: Clinical endocrinology
  • URL: https://probl-endojournals.ru/probl/article/view/10246
  • DOI: https://doi.org/10.14341/probl10246
  • Cite item
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Abstract


BACKGROUND: The most of the current studies include patients who are different by the etiology of secondary adrenal insufficiency (SAI), or investigate SAI among other late effects of the radiation therapy.

AIMS: To describe the features of SAI and to select the best method of screening SAI in adult patients followed complex treatment of nonpituitary brain tumors in childhood.

MATERIALS AND METHODS: It was the retrospective cross-sectional study. 31 patients after the complex treatment of nonpituitary brain tumors in childhood and 20 healthy volunteers were examined. Age and sex ratio were comparable between the groups. Biochemical and clinical blood tests, levels of cortisol, ACTH, DHEA-C were evaluated. The insulin tolerance test (ITT) was performed for all patients and 11 volunteers.

RESULTS: The prevalence of SAI by ITT was 45.2%. The levels of basal cortisol (BC) were significantly higher in patients without SAI in comparison with the SAI group and volunteers (505 [340; 650] vs 323 [233; 382] and 372 [263; 489] nmol / l; pSAI- without_SAI=0.001; pwihtout_SAI-healthy = 0.04). The SAI group had DHEA-C significantly lower than in other groups one (3.1 [1.8; 3.4] vs 5.1 [2.5; 6.4] and 6.8 [4.1; 8.9]; рSAI- without_SAI = 0.036; pSAI-healthy = 0.001). ROC analysis showed that BC and DHEA-S can be used as high-quality screening tests for SAI (AUC = 89.3% and 88.3%). The maximum level of cortisol (656 [608-686] vs 634 [548-677]; p = 1) and the time of its increase (45 and 60 min) did not differ during ITT in patients without SAI and volunteers. Side effects: delayed hypoglycemia occurred in 4/14 patients of the SAI group 40–90 minutes late of injection 60-80 ml of 40% glucose solution for stopping hypoglycemia in the test.

CONCLUSIONS: 45.2% of patients followed craniospinal irradiation had SAI that is characterized by a decrease in DHEA-C levels. A highly normal level of basal cortisol was observed in 45% of patients without SAI. DHEA-C and blood cortisol can be used for SAI screening.


Alla E. Yudina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: alla1301@yandex.ru
ORCID iD: 0000-0002-4704-8453
SPIN-code: 9307-7889

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Postgraduate student, M.D. Chair of endocrinology

Maria G. Pavlova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: mgpavlova68@rambler.ru
ORCID iD: 0000-0001-6073-328X
SPIN-code: 2205-1288

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Ph.D., M.D.endocrinologist, Chair of endocrinology

Vladimir M. Sotnikov

Russian Scientific Center of Roentgeno-Radiology

Email: vmsotnikov@mail.ru
ORCID iD: 0000-0003-0498-314X
SPIN-code: 3845-0154

Russian Federation, 86, Profsoyuznaya street, Moscow, 117997

MD, PhD, Professor, Leading Researcher, Head of the X-ray and combined therapy methods department

Alla E. Yudina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: alla1301@yandex.ru
ORCID iD: 0000-0002-4704-8453
SPIN-code: 9307-7889

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

Postgraduate student, M.D. Chair of endocrinology

Yulia P. Sych

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: juliasytch@mail.ru
ORCID iD: 0000-0002-7000-0095
SPIN-code: 3406-0978

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD

Nadezhda A. Mazerkina

N.N. Burdenko National Scientific and Practical Center for Neurosurgery

Email: nmazer@nsi.ru
ORCID iD: 0000-0002-0428-0498
SPIN-code: 1012-2923

Russian Federation, 16, 4-ya Tverskaya-Yamskaya street, Moscow, 125047

P.h.d., M.D.endocrinologist

Olga G. Zheludkova

Russian Scientific Center of Roentgenoradiology

Email: clelud@mail.ru
ORCID iD: 0000-0002-8607-3635
SPIN-code: 4850-7788

Russian Federation, 86, Profsoyuznaya street, Moscow, 117997

PhD, MD, oncologist

Nadezhda B. Teryaeva

Russian Scientific Center of Roentgenoradiology

Email: nteryaeva@nsi.ru
ORCID iD: 0000-0001-8535-8535
SPIN-code: 2822-3279

Russian Federation, 86, Profsoyuznaya street, Moscow, 117997

Phd

Andrey N. Gerasimov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: andr-gerasim@yandex.ru
ORCID iD: 0000-0003-4549-7172
SPIN-code: 4742-1459

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

PhD, DSc., Head of the department of Medical Statistics and Informatics

Evgeniya Martynova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: doctor.martynova@gmail.com
ORCID iD: 0000-0002-0681-4772
SPIN-code: 4992-0837

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD

Ekaterina I. Kim

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: kat-alex2007@mail.ru
ORCID iD: 0000-0001-7879-8495
SPIN-code: 1628-2139

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

medical student

Marina A. Berkovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: abaitamar@gmail.com
ORCID iD: 0000-0003-4974-7765
SPIN-code: 4251-7117

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

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Supplementary files

Supplementary Files Action
1. Fig. 1. Scheme of a research. View (154KB) Indexing metadata
2. Fig. 2. Structure and prevalence of distant endocrine effects after undergoing complex treatment of extragipophysical tumors. View (44KB) Indexing metadata
3. Fig. 3. Structure of distant endocrine effects in groups with and without BHH. View (20KB) Indexing metadata
4. Fig. 4. Complaints filed by patients after treatment of extragipophysical tumors, depending on the presence or absence of BHH. View (103KB) Indexing metadata
5. Fig. 5. Median and interquartile interval of cortisol levels against TIG background by groups. View (85KB) Indexing metadata
6. Fig. 6. Median and interquartile interval for ACTH by time points against TIG background. View (113KB) Indexing metadata

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Copyright (c) 2020 Yudina A.E., Pavlova M.G., Sotnikov V.M., Yudina A.E., Sych Y.P., Mazerkina N.A., Zheludkova O.G., Teryaeva N.B., Gerasimov A.N., Martynova E., Kim E.I., Berkovskaya M.A.

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