Clinical features and diagnosis of secondary adrenal insufficiency followed complex treatment non-pituitary brain tumors

  • Authors: Yudina A.1, Pavlova M.1, Sotnikov V.2, Tselovalnikova T.1, Mazerkina N.3, Zheludkova O.2, Gerasimov A.1, Teryaeva N.4, Martynova E.4, Kim E.1
  • Affiliations:
    1. I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
    2. Russian Scientific Center of Roentgeno-Radiology, Moscow, Russian Federation
    3. N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation
    4. N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation.
  • URL: https://probl-endojournals.ru/probl/article/view/10246
  • DOI: https://doi.org/10.14341/probl10246
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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 analyze the changes occurring in the hypothalamic-pituitary-adrenal axis after craniospinal irradiation and to describe the features of SAI in adult patients followed complex treatment of non-pituitary brain tumors in childhood.

Materials and methods: It was the retrospective cross-sectional study. 31 patients after the complex treatment of non-pituitary 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;p SAI- without_SAI=0.001; p wihtout_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]; р SAI- without_SAI = 0.036; p SAI-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 Yudina

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

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

Russian Federation, 1/1, Pogodinskaya street, 119991, Moscow, Russia

MD

Maria Pavlova

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Email: mgp.med@gmail.com
ORCID iD: 0000-0001-6073-328X
SPIN-code: 2205-1288

Russian Federation

Vladimir Sotnikov

Russian Scientific Center of Roentgeno-Radiology, Moscow, Russian Federation

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

Russian Federation

MD, PhD, professor

Tatyana Tselovalnikova

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

Email: t.tselovalnikova@gmail.com
ORCID iD: 0000-0002-4704-8453
SPIN-code: 2688-6494

Russian Federation

Nadezhda Mazerkina

N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation

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

Russian Federation

Olga Zheludkova

Russian Scientific Center of Roentgeno-Radiology, Moscow, Russian Federation

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

Russian Federation

MD, PhD, professor

Andrey Gerasimov

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

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

Phd, professor

Nadezhda Teryaeva

N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation.
 

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

Russian Federation

Phd

Evgeniya Martynova

Email: doctor.martynova@gmail.com
ORCID iD: 0000-0002-0681-4772
SPIN-code: 4992-0837
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

MD

Ekaterina Kim

I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation

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

Russian Federation

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