A 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.

In rare cases, it has been associated with pituitary apoplexy

Pituitary apoplexy

Pituitary apoplexy or pituitary tumor apoplexy is bleeding into or impaired blood supply of the pituitary gland at the base of the brain. This usually occurs in the presence of a tumor of the pituitary, although in 80% of cases this has not been diagnosed previously...

.

Process

Three hormone

Hormone

A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

s (usually synthetic analogues

Analog (chemistry)

In chemistry, a structural analog , also known as chemical analog or simply analog, is a compound having a structure similar to that of another one, but differing from it in respect of a certain component. It can differ in one or more atoms, functional groups, or substructures, which are replaced...

) are injected as a bolus

Bolus (medicine)

In medicine, a bolus is the administration of a medication, drug or other compound that is given to raise its concentration in blood to an effective level...

 into the patient's vein to stimulate the anterior pituitary

Anterior pituitary

A major organ of the endocrine system, the anterior pituitary, also called the adenohypophysis, is the glandular, anterior lobe of the pituitary gland...

 gland:

• insulin
  Insulin
  Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
  
  
• gonadotropin-releasing hormone
  Gonadotropin-releasing hormone
  Gonadotropin-releasing hormone , also known as Luteinizing-hormone-releasing hormone and luliberin, is a tropic peptide hormone responsible for the release of follicle-stimulating hormone and luteinizing hormone from the anterior pituitary. GnRH is synthesized and released from neurons within...
  
   (GnRH)
• thyrotropin-releasing hormone
  Thyrotropin-releasing hormone
  Thyrotropin-releasing hormone , also called thyrotropin-releasing factor , thyroliberin or protirelin, is a tropic tripeptide hormone that stimulates the release of thyroid-stimulating hormone and prolactin by the anterior pituitary...
  
   (TRH)

The gland's response is assessed by measuring the rise in cortisol

Cortisol

Cortisol is a steroid hormone, more specifically a glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat,...

 and growth hormone

Growth hormone

Growth hormone is a peptide hormone that stimulates growth, cell reproduction and regeneration in humans and other animals. Growth hormone is a 191-amino acid, single-chain polypeptide that is synthesized, stored, and secreted by the somatotroph cells within the lateral wings of the anterior...

 (GH) in response to the hypoglycaemia caused by insulin, rises in prolactin

Prolactin

Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...

 and thyroid-stimulating hormone

Thyroid-stimulating hormone

Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...

 (TSH) caused by TRH and rises in luteinizing hormone

Luteinizing hormone

Luteinizing hormone is a hormone produced by the anterior pituitary gland. In females, an acute rise of LH called the LH surge triggers ovulation and development of the corpus luteum. In males, where LH had also been called interstitial cell-stimulating hormone , it stimulates Leydig cell...

 (LH) and follicle-stimulating hormone

Follicle-stimulating hormone

Follicle-stimulating hormone is a hormone found in humans and other animals. It is synthesized and secreted by gonadotrophs of the anterior pituitary gland. FSH regulates the development, growth, pubertal maturation, and reproductive processes of the body. FSH and Luteinizing hormone act...

 (FSH) caused by GnRH. Blood glucose

Glucose

Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...

 levels are also monitored to ensure appropriate levels of hypoglycemia

Hypoglycemia

Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...

 are achieved.

History

The triple bolus test was introduced in 1973 by physicians from the London Royal Postgraduate Medical School

Royal Postgraduate Medical School

The Royal Postgraduate Medical School was an independent medical school, based primarily at Hammersmith Hospital in west London. In 1988, the school merged with the Institute of Obstetrics & Gynaecology, and in 1997 became part of the Imperial College School of Medicine.-History:The medical school...

 and Queen Elizabeth Hospital, Birmingham

Queen Elizabeth Hospital, Birmingham

The Queen Elizabeth Hospital Birmingham is an NHS hospital in the Edgbaston area of Birmingham, situated very close to the University of Birmingham. The hospital, which cost £545 million to construct, opened in June 2010 replacing the previous Queen Elizabeth Hospital and Selly Oak Hospital...

. It followed earlier reports combining insulin and vasopressin

Vasopressin

Arginine vasopressin , also known as vasopressin, argipressin or antidiuretic hormone , is a neurohypophysial hormone found in most mammals, including humans. Vasopressin is a peptide hormone that controls the reabsorption of molecules in the tubules of the kidneys by affecting the tissue's...

 analogues in the diagnosis of hypopituitarism.

See also

• Insulin tolerance test
  Insulin tolerance test
  An insulin tolerance test is a medical diagnostic procedure during which insulin is injected into a patient's vein to assess pituitary function, adrenal function, and sometimes for other purposes. An ITT is usually ordered and interpreted by endocrinologists.Insulin injections are intended to...
  
  
• ACTH stimulation test
  ACTH stimulation test
  The ACTH stimulation test is a medical test usually ordered and interpreted by endocrinologists to assess the functioning of the adrenal glands stress response by measuring the adrenal response to adrenocorticotropic hormone...
  
  
• Hypopituitarism
  Hypopituitarism
  Hypopituitarism is the decreased secretion of one or more of the eight hormones normally produced by the pituitary gland at the base of the brain...
  
  
• Triple test
  Triple test
  The triple test, also called triple screen, the Kettering test or the Bart's test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities .The term "multiple-marker screening test" is sometimes used...