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TRF test in patients with hypothalamic-pituitary disorders.

TRF test with 50-100μg of synthetic TRF was performed in 57 patients with hypothalamic-pituitary disorders. According to the degree and the pattern of TSH response, they were classified as an absent, subnormal, normal or supernormal response and/or delayed pattern of TSH response. 9 of 21 patients with pituitary chromophobe adenoma showed an absent or a subnormal response. Six of them were hypothyroid. 21 of 23 patients with hypothalamic lesions had normal or supernormal TSH response. 5 with a normal response and all of the six with a supernormal response showed clinical or biochemical evidence of hypothyroidism. Since the pituitary of these cases remained intact from tumor invasion, they should be postulated as hypothalamic hypothyroidism. A delayed pattern of TSH response to TRF, where the peak TSH response occurred after 20min, was observed in 17 of 23 in hypothalamic lesions. 6 of 7 patients with diabetes insipidus showed just the same pattern of TSH response as observed in the patients with determined hypothalamic lesions. This delayed pattern of response and normal or supernormal response to a small dose of TRF, such as 50-100μg, could be used to distinguish hypothalamic lesions from pituitary diseases.