Combined rapid anterior pituitary evaluation panel

Combined rapid anterior pituitary evaluation panel
OPS-301 code	1-797

A combined rapid anterior pituitary evaluation panel or triple bolus test or a dynamic pituitary function test is a medical diagnostic procedure used to assess a patient's pituitary function. A triple bolus test is usually ordered and interpreted by endocrinologists.^[citation needed]

In rare cases, it has been associated with pituitary apoplexy.[1]

Process

Three hormones[2] (usually synthetic analogues) are injected as a bolus into the patient's vein to stimulate the anterior pituitary gland:

• insulin
• gonadotropin-releasing hormone (GnRH)
• thyrotropin-releasing hormone (TRH)

The gland's response is assessed by measuring the rise in cortisol and growth hormone (GH) in response to the hypoglycaemia caused by insulin, rises in prolactin and thyroid-stimulating hormone (TSH) caused by TRH and rises in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) caused by GnRH. Blood glucose levels are also monitored to ensure appropriate levels of hypoglycemia are achieved.^[citation needed]

History

The triple bolus test was introduced in 1973 by physicians from the London Royal Postgraduate Medical School and Queen Elizabeth Hospital, Birmingham.[3] It followed earlier reports combining insulin and vasopressin analogues in the diagnosis of hypopituitarism.[4]

See also

• Insulin tolerance test
• ACTH stimulation test
• Hypopituitarism
• Triple test

References

1. Yoshino A, Katayama Y, Watanabe T, et al. (June 2007). "Apoplexy accompanying pituitary adenoma as a complication of preoperative anterior pituitary function tests". Acta Neurochir (Wien). 149 (6): 557–65, discussion 565. doi:10.1007/s00701-007-1155-8. PMID 17468811. S2CID 24978106.
2. Melmed, Shlomo (2002). The pituitary. Wiley-Blackwell. pp. 714–. ISBN 978-0-632-04357-6. Retrieved 15 July 2011.
3. Harsoulis P, Marshall JC, Kuku SF, Burke CW, London DR, Fraser TR (November 1973). "Combined test for assessment of anterior pituitary function". Br Med J. 4 (5888): 326–9. doi:10.1136/bmj.4.5888.326. PMC 1587416. PMID 4202260.
4. Greenwood FC, Landon J (May 1966). "Assessment of hypothalamic pituitary function in endocrine disease". J. Clin. Pathol. 19 (3): 284–92. doi:10.1136/jcp.19.3.284. PMC 473256. PMID 4287115.