A triple bolus test is usually ordered and interpreted by endocrinologists.
[citation needed] In rare cases, it has been associated with pituitary apoplexy.
[1] Three hormones[2] (usually synthetic analogues) are injected as a bolus into the patient's vein to stimulate the anterior pituitary gland: 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.
[citation needed] 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.