An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic–pituitary disease

Leong, King Sun; Walker, A. B.; Martin, I. K.; Wile, D.; Wilding, John; MacFarlane, I. A.

doi:10.1046/j.1365-2265.2001.01169.x

Cited by 132 publications

(127 citation statements)

References 33 publications

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“…Additionally, no correlation between BMI and age to peak GH responses were observed, peak GH responses occurred mainly between 120 and 180 minutes consistent with previous studies, 27,30 and that, overall, the GST was a well tolerated test. Nevertheless, these 21,22,28 and previous studies 20,23,24,31 did not specifically evaluate patients with glucose intolerance and frank diabetes and, for this reason, the characteristic of the GST and its reliability in testing for GHD in this population remains unclear.…”

Section: Historical Perspective Of the Use Of Glucagon Stimulation Tesupporting

confidence: 74%

“…25 The GST was initially described as a 4-hour test in older studies, 33 31 Accordingly, the authors proposed that the diagnostic utility of the simplified GST could be improved further by drawing an additional blood sample at 210 minutes when assessing GH deficiency. The audit by Leong et al 27 reported that the GST could be shortened by omitting the 240-minute blood sample. In this study of 414 patients, the majority of peak GH levels occurred between 120 and 180 minutes (85 %), and five patients had their peak GH levels recorded at 240 minutes.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the hypothesized mechanisms include the glycemic fluctuations during the test where blood glucose levels increase initially before decreasing later in the test, 25 the generation of a peptidyl fragment associated with the GH-and adrenocorticotropic hormone (ACTH)-releasing activity, 26 and the induction of norepinephrine secretion in stimulating GH release via a-receptors. 27 It has also been previously demonstrated that glucagon stimulates GH release more effectively when administered intramuscularly or subcutaneously compared with the intravenous route. 23 The three studies utilizing the GST by Gomez et al, 28 Conceicao et al 22 and…”

Section: Historical Perspective Of the Use Of Glucagon Stimulation Tementioning

confidence: 99%

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Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Yuen

2014

US Endocrinology

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Growth hormone deficiency (GHD) in adults is characterized by alterations in body composition, carbohydrate and lipid metabolism, bone mineral density, cardiovascular risk profile, and quality of life.1 Treatment with GH replacement has been shown to improve many, but not all, of these abnormalities. 2 By contrast, untreated GHD is associated with increased mortality and morbidity that was previously observed in adults with hypopituitarism. 3,4 These findings were substantiated in two large surveys based on national Danish registries, 5,6 where the morbidity of adults with GHD was found to be approximately threefold higher than that of a healthy population. This result was independent of gender and applied to patients with childhood-onset and adult-onset GHD, with mortality of childhoodonset GHD far exceeding that of adult-onset GH deficient patients. 6Current published consensus guidelines recommend the evaluation of adult GHD to be based on clinical findings, medical history and using the appropriate GH stimulation test for biochemical confirmation, 7-9 with the exception of patients with three or more pituitary hormone deficiencies and low serum insulin-like growth factor 1 (IGF-1) levels. 10 Serum IGF-1 levels should not be used alone to diagnose adult GHD and the maximum or peak GH secretion following GH stimulation testing is used as a surrogate of the capacity of the pituitary to release GH. The insulin tolerance test (ITT) is widely considered as the gold standard test for evaluation of GH deficiency and has been endorsed by several consensus guidelines. [7][8][9]11 However, this test is labor intensive, may be unpleasant for some patients, has potential risks, and is contraindicated in elderly patients and in patients with seizure disorders and ischemic heart disease. AbstractGrowth hormone deficiency (GHD) is a well-recognized clinical syndrome in adults, and its diagnosis is established through one or more GH stimulation tests. The decision to perform GH stimulation testing should be based on medical history and clinical findings, and using appropriate GH stimulation test/s for biochemical confirmation. The insulin tolerance test (ITT) remains the diagnostic test of choice; however, this test is labor intensive, contraindicated in the elderly and in adults with seizure disorders and ischemic heart disease, can be unpleasant for the patient, and is potentially hazardous. With the discontinuation of the growth hormone releasing hormone (GHRH) analog (Geref ® ) in the US in 2008, the glucagon stimulation test (GST) has gained increasing popularity as the alternative test to the ITT because of its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GH deficiency (GHD), and relatively few contraindications. In this article, recommendations for performing this test, the potential drawbacks in conducting and caveats in interpreting this test, and its future perspectives are discussed.

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Section: Historical Perspective Of the Use Of Glucagon Stimulation Tesupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Historical Perspective Of the Use Of Glucagon Stimulation Tementioning

confidence: 99%

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Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Yuen

2014

US Endocrinology

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“…Our Endocrine Unit uses the GST as the first-line GH provocation test (16), which has been validated previously (25,26) and has been shown to be equivalent to the ITT (27,28). The Endocrine Society in its recent guidelines acknowledged the role of the GST for the diagnosis of GHD, particularly in the face of the recent shortage of GHRH (29) and in cases where the ITT may be contra-indicated (9, 10).…”

Section: Discussionmentioning

confidence: 99%

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Gardner

Javadpour

Stoneley

et al. 2013

European Journal of Endocrinology

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Objective: Hypopituitarism following subarachnoid haemorrhage (SAH) has been reported to be a frequent occurrence. However, there is considerable heterogeneity between studies with differing patient populations and treatment modalities and most importantly employing differing endocrine protocols and (normal) reference ranges of GH. We aimed to examine prospectively a cohort of SAH survivors for development of hypopituitarism post-SAH using rigorous endocrine testing and compare GH response to glucagon stimulation with a cohort of healthy controls of a similar BMI. Design and methods: Sixty-four patients were investigated for evidence of hypopituitarism 3 months post-SAH with 50 patients tested again at 12 months. Glucagon stimulation testing (GST), with confirmation of deficiencies by GHRH/arginine testing for GH deficiency (GHD) and short synacthen testing for ACTH deficiency, was used. Basal testing of other hormonal axes was undertaken. Results: Mean age of patients was 53G11.7 years and mean BMI was 27.5G5.7 kg/m 2 . After confirmatory testing, the prevalence of hypopituitarism was 12% (GHD 10%, asymptomatic hypocortisolaemia 2%). There was no association between hypopituitarism and post-SAH vasospasm, presence of cerebral infarction, Fisher grade, or clinical grading at presentation. There was a significant correlation between BMI and peak GH to glucagon stimulation in both patients and controls. Conclusions: Identification of 'true' GHD after SAH requires confirmatory testing with an alternative stimulation test and application of BMI-specific cut-offs. Using such stringent criteria, we found a prevalence of hypopituitarism of 12% in our population.

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“…It is safe, with low cost, few contraindications, and an effective test to assess both GH and ACTH secretion (12). So far, few studies have evaluated GH response to GST.…”

Section: Introductionmentioning

confidence: 99%

Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men

Micmacher

Assumpção

Redorat

et al. 2009

Arq Bras Endocrinol Metab

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Objective: To investigate the growth hormone (GH) response to glucagon stimulation test (GST) in a population of healthy men over 50 years old in comparison to insulin tolerance test (ITT), analysis of the spontaneous 24-hour GH profile and insulin-like growth factor 1 (IGF-I). Me thods: 27 healthy men aged between 51 and 65 years were tested. Results: Using non-parametric correlation analysis, a positive correlation between GH peak after GST and mean IGF-I (r = 0.528; p = 0.005) was found, as well with GH peak in 24-hour profile (r = 0.494; p = 0.009). No correlation was found comparing GH peak after ITT with the same parameters. Ten subjects presented GH peak of less than 3.0 μg/L after GST, none confirmed in ITT. Conclusions: GH peak response to GST was lower than ITT, but it showed a positive correlation with mean IGF-I and also with GH peak in 24-hour profile. However, GST should not be used to differentiate organic growth hormone deficiency (GDH) from the expected decline on GH secretion due to aging. Arq Bras Endocrinol Metab. 2009;53(7):853-8. KeywordsGrowth hormone; somatopause; glucagon RESUMO Objetivo: Investigar a resposta do hormônio do crescimento (GH) ao teste de estímulo com glucagon (GST) numa população de homens saudáveis acima dos 50 anos de idade, em comparação ao teste de tolerância à insulina (ITT), além da análise do perfil de secreção espontânea de GH nas 24 horas e fator de crescimento semelhante à insulina (IGF-I) basal. Métodos: 27 homens, com idades entre 51 e 65 anos, foram submetidos aos testes. Resultados: Utilizando análise de correlação não paramétrica, encontrou-se correlação positiva entre o pico de GH pós-GST e a média de IGF-I (r = 0,528; p = 0,005), e também com o pico espontâneo do GH no perfil de 24 horas (r = 0,494; p = 0,009). Não houve correlação do pico de GH pós-ITT com os mesmos parâmetros. Dez indivíduos apresentaram pico de GH após GST inferior a 3,0 μg/L, sem confirmação no ITT. Conclusões: O pico de GH pós-GST foi menor do que o obtido pós-ITT, porém demonstrou correlação positiva com a média de IGF-I e o pico de GH na secreção espontânea de 24 horas. Entretanto, o GST não demonstrou ser um bom teste para distinguir entre deficiência de hormônio de crescimento (DGH) e somatopausa. Arq Bras Endocrinol Metab. 2009;53(7):853-8. DescritoresHormônio do crescimento; somatopausa; glucagon

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An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic–pituitary disease

Abstract: This large audit has shown that the glucose stimulation test is well tolerated and can easily be performed in an out-patient setting with minimal medical supervision. The 240 minute sample added little additional information and could be omitted.

Cited by 132 publications

References 33 publications

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men

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An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic–pituitary disease

Abstract: This large audit has shown that the glucose stimulation test is well tolerated and can easily be performed in an out-patient setting with minimal medical supervision. The 240 minute sample added little additional information and could be omitted.

Cited by 132 publications

References 33 publications

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men

Contact Info

Product

Resources

About

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update