Abstract

Objective: Adrenal insufficiency is a life-threatening disease and therefore, accurate diagnosis and prompt treatment are life-saving. The main purpose of this study was to retrospectively evaluate the serum cortisol levels measured during the L-dopa test in cases suspected GH deficiency and to compare the effect of L-dopa on cortisol secretion with the results of previous studies.

Method: Between January 2019 and January 2021, patients who underwent the L-dopa test for the evaluation of GH deficiency in our Pediatric Endocrinology Clinic and whose basal cortisol levels were measured at the baseline and at the 120th minutes of the test were included. The clinical, anthropometric, and laboratory data of the patients were obtained from the medical records.

Results: Eighty-five patients (38 girls, 47 boys) were included in the study. The mean age of the patients was 10.3 ± 3.5 years (range, 4.1 - 14.9 years). The mean serum cortisol level was 11.1 ± 3.6 µg/dL at baseline and 20.9 ± 3.8 µg/dL at 120th minutes (the mean cortisol increase was 9.8 ± 4.1 µg/dL). Cortisol response was adequate (> 18 µg / dL) in 76 cases (89.4%). Nausea/vomiting was observed in 53 (62.4%) of the patients during the L-dopa test. Peak cortisol responses of the cases with and without side effects were similar (20.9 ± 3.8; 20.8 ± 3.7; p = 0.945).

Conclusion: In conclusion, the L-dopa test is easy to apply, effective, and safe and can be performed to evaluate cortisol adequacy at least in patients being evaluated for suspected GH deficiency.

Keywords: Adrenal function, adrenal insufficiency, cortisol, cortisol deficiency, dopamine agonist, L-dopa

Copyright and license

Copyright © 2023 The author(s). This is an open-access article published by Aydın Pediatric Society under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Kırkgöz T, Acar S, Nalbantoğlu Ö, Özkan B. Results confirming the efficacy of oral L-dopa on cortisol secretion in patients being evaluated for suspected growth hormone deficiency. Trends in Pediatrics. 2023;4(1):19-23. https://doi.org/10.59213/TP.2023.40316

References

  1. Buonocore F, McGlacken-Byrne SM, Del Valle I, Achermann JC. Current insights into adrenal insufficiency in the newborn and young infant. Front Pediatr. 2020;8:619041. https://doi.org/10.3389/fped.2020.619041
  2. Rogol AD, Hayden GF. Etiologies and early diagnosis of short stature and growth failure in children and adolescents. J Pediatr. 2014;164:S1-14.e6. https://doi.org/10.1016/j.jpeds.2014.02.027
  3. Shah A, Stanhope R, Matthew D. Hazards of pharmacological tests of growth hormone secretion in childhood. BMJ. 1992;304:173-4. https://doi.org/10.1136/bmj.304.6820.173
  4. Lim SH, Vasanwala R, Lek N, Yap F. Quantifying the risk of hypoglycaemia in children undergoing the glucagon stimulation test. Clin Endocrinol (Oxf). 2011;75:489-94. https://doi.org/10.1111/j.1365-2265.2011.04117.x
  5. Marakaki C, Papadimitriou DT, Kleanthous K, Papadopoulou A, Papadimitriou A. L-dopa stimulates cortisol secretion through adrenocorticotropic hormone release in short children. Horm Res Paediatr. 2015;84:319-22. https://doi.org/10.1159/000439532
  6. Marakaki C, Papadimitriou DT, Papadopoulou A, Fretzayas A, Papadimitriou A. L-dopa is a potent stimulator of cortisol in short children. Horm Res Paediatr. 2014;81:386-90. https://doi.org/10.1159/000357268
  7. Acar S, Paketçi A, Tuhan H, Demir K, Böber E, Abaci A. Comparison of the effects of the L-dopa and insulin tolerance tests on cortisol secretion. J Endocrinol Invest. 2018;41:901-7. https://doi.org/10.1007/s40618-017-0815-7
  8. Neyzi O, Bundak R, Gökçay G, et al. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol. 2015;7:280-93. https://doi.org/10.4274/jcrpe.2183
  9. King AB. The effect of exogenous dopamine on ACTH secretion. Proc Soc Exp Biol Med. 1969;130:445-7. https://doi.org/10.3181/00379727-130-33575
  10. Hayek A, Crawford JD. L-DOPA and pituitary hormone secretion. J Clin Endocrinol Metab. 1972;34:764-6. https://doi.org/10.1210/jcem-34-5-764
  11. Nilsson KO, Thorell JI. The effect of L-dopa on the blood concentrations of growth hormone, thyrotrophin, gonadotrophins, cortisol and glucose in children with short stature. Acta Paediatr Scand. 1974;63:812-6. https://doi.org/10.1111/j.1651-2227.1974.tb04869.x
  12. Vizner B, Reiner Z, Sekso M. Effect of l-dopa on growth hormone, glucose, insulin, and cortisol response in obese subjects. Exp Clin Endocrinol. 1983;81:41-8. https://doi.org/10.1055/s-0029-1210205
  13. Chambers JW, Brown GM. Neurotransmitter regulation of growth hormone and ACTH in the rhesus monkey: effects of biogenic amines. Endocrinology. 1976;98:420-8. https://doi.org/10.1210/endo-98-2-420
  14. Stratakis CA, Rusovici DE, Kulin HE, Finkelstein JW. Dysregulation of the hypothalamic-pituitary-adrenal axis in short children with and without growth hormone deficiency. J Pediatr Endocrinol Metab. 2000;13:1095-100. https://doi.org/10.1515/jpem.2000.13.8.1095
  15. Philippi H, Pohlenz J, Grimm W, Koffler T, Schönberger W. Simultaneous stimulation of growth hormone, adrenocorticotropin and cortisol with L-dopa/L-carbidopa and propranolol in children of short stature. Acta Paediatr. 2000;89:442-6. https://doi.org/10.1080/080352500750028168
  16. Franco R, Reyes-Resina I, Navarro G. Dopamine in health and disease: much more than a neurotransmitter. Biomedicines. 2021;9:109. https://doi.org/10.3390/biomedicines9020109
  17. Pivonello R, Ferone D, Lombardi G, Colao A, Lamberts SWJ, Hofland LJ. Novel insights in dopamine receptor physiology. Eur J Endocrinol. 2007;156 Suppl 1:S13-21. https://doi.org/10.1530/eje.1.02353
  18. Itoi K, Suda T, Tozawa F, et al. Microinjection of norepinephrine into the paraventricular nucleus of the hypothalamus stimulates corticotropin-releasing factor gene expression in conscious rats. Endocrinology. 1994;135:2177-82. https://doi.org/10.1210/endo.135.5.7956940
  19. Shirtcliff EA, Allison AL, Armstrong JM, Slattery MJ, Kalin NH, Essex MJ. Longitudinal stability and developmental properties of salivary cortisol levels and circadian rhythms from childhood to adolescence. Dev Psychobiol. 2012;54:493-502. https://doi.org/10.1002/dev.20607
  20. Moskow DM, Addington J, Bearden CE, et al. The relations of age and pubertal development with cortisol and daily stress in youth at clinical risk for psychosis. Schizophr Res. 2016;172:29-34. https://doi.org/10.1016/j.schres.2016.02.002