What tests should be done when you have hypothermic coma? Function measurement of pituitary-gonadal system 1. Gonadal function test: It is generally believed that the first thing that is impaired in hypopituitarism is the reduction of gonadotropin secretion, so the direct measurement of sex hormone content in blood and urine can understand the function of gonads and help in early diagnosis. In women, estradiol and progesterone can be measured, and in men, testosterone in plasma can be measured. Others, such as endometrial atrophy and vaginal epithelial atrophy, can provide indirect evidence. 2. Gonadotropin (FSH, LH) measurement: follicle stimulating hormone (FSH) and luteinizing hormone (LH) are reduced in patients with this disease. Normal values in prepubertal male blood FSH is about 120ng/ml and LH is about 40ng/ml; female FSH is 20-80ng/ml and LH is about 30ng/ml; adult male blood FSH is 70-180ng/ml and LH is <34-58ng/ml. 3. Luteinizing hormone releasing hormone (LH-RH) excitation test: intravenous injection of 50 µg / time, normal people 15min after the blood LH (or chorionic gonadotropin) has a significant increase, the average increase to more than 3 times the base value, the absolute value of about 7.5ng/ml or more. If there is no response, it indicates poor reserve capacity of the pituitary gland. In patients with secondary hypothalamic lesions, this test shows a delayed response and requires intravenous or intramuscular injection of LH-RH 50-100µg/time, once every other day, for a total of 3 times before a rise in LH is seen. In general, due to hypopituitarism, the pituitary gland mostly shows a weak response even under LH-RH stimulation. However, a few atypical patients with this disease can also show normal responses, probably because some normal cells still exist in the pituitary gland, so the low response to LH-RH excitation can help the diagnosis, but the possibility of this disease cannot be ruled out when normal responses are shown. 4, clomifene (clomiphene, clomiphene) test: oral 50-100mg / d, 5 days; normal people can be seen after taking the drug LH (men can be measured at the same time testosterone) a significant increase, the increase can be more than 2-4 times the base value. The mechanism may be that the drug competes with estrogen for receptors in the hypothalamus, thus relieving the negative feedback inhibitory effect of estrogen on the hypothalamus, thus increasing the secretion of hypothalamic gonadotropin-releasing hormone and causing the pituitary gland to produce more LH. Determination of the function of the pituitary-thyroid system: 1. Thyroid function test: Direct determination of the concentration of total thyroid hormone (T3, T4) in the peripheral blood by RIA method Patients with this disorder may have reduced thyroid hormone levels (T3 80-230ng/dl, T4 3.6-14µg/dl, FT3 2.5-4.7pg/ml, FT4 9-14pg/ml in normal subjects, Shanghai Ruijin Hospital); in addition, the uptake rate of thyroid 131Ⅰ or 125I-T3/denatured albumin particles can be measured. uptake ratio, 125I-T3 resin uptake rate, etc. 2, plasma thyrotropin (TSH) measurement and thyrotropin-releasing hormone (TRH) excitation test: the basal value of TSH in the serum of patients with this disease decreases (normal value TSH 0-15µU/ml, S-TSH 0.3-5µU/ml, Shanghai Ruijin Hospital); because the basal value of TSH in some normal people (about 20%) can also be undetectable, it is appropriate to perform TRH excitation test to The TRH excitation test is performed to detect the reserve capacity of the pituitary gland. The TRH excitation test in patients with this disorder shows a weak or no response, and those with lesions in the hypothalamus show a delayed response. Adrenocortical function test: In severe cases, the pituitary-adrenal system is involved, which may result in insufficient production of adrenocorticotropic hormone, reduced 17-hydroxysteroids and free cortisol in the urine, and loss or weakening of the water diuretic effect of corticosteroids, i.e., the maximum urine output per minute in the test is <10 ml, which may be accompanied by low fasting blood glucose, flattened glucose tolerance curve, low 11-hydroxysteroids in blood or plasma glucose. It may be accompanied by low fasting glucose, flat glucose tolerance curve, abnormal circadian curve of 11-hydroxysteroid or plasma cortisol. 2.Pituitary adrenocorticotropic hormone test: measurement of adrenocorticotropic hormone (ACTH) in blood, suggesting reduced secretion of ACTH. 3, ACTH excitation test: normal people intravenous drip ACTH 25U/d, 2 days later, the production of 17-hydroxysteroids in the urine increased by 10mg or more than 3 times than before the drug, the absolute count of eosinophils in the blood after the drip decreased by 80% to 90% than before the drug; this disease is delayed reaction, primary chronic hyperalgesia always presents adverse reactions, but ACTH drip has a metabolic reaction However, ACTH drip has the risk of metaplasia and water toxicity, so it should be applied with caution. 4, metyrapone (metyrapone, metopirone, metopirone, Su4885) test: this drug can inhibit 11β-hydroxylase in the adrenal cortex, so that cortisol synthesis is reduced, staying in the 11-deoxycortisol stage, through negative feedback on the pituitary gland secretion of ACTH inhibition is weakened, so the urinary 17-hydroxy corticosteroids in normal people significantly increased, can reach The urinary 17-hydroxycorticosteroids are significantly elevated in normal subjects and can be more than twice as high as before drug administration. If there is no significant elevation, the reserve capacity for ACTH secretion is insufficient.