Clinical characteristics, timing of peak responses and safety aspects of two dosing regimens of the glucagon stimulation test in evaluating growth hormone and cortisol secretion in adults

Yuen, Kevin C.J.; Biller, Beverly M. K.; Katznelson, Laurence; Rhoads, Sharon A.; Gurel, Michelle H.; Chu, Olivia; Corazzini, Valentina; Spiller, Kellie; Gordon, Murray B.; Salvatori, Roberto; Cook, David M.

doi:10.1007/s11102-012-0407-7

Cited by 45 publications

(31 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…32 In this study, we found that peak and nadir glucose, and delta GH, were higher in the weight-based regimen. In both regimens, BMI, fasting, peak, and nadir glucose correlated negatively with peak GH levels.…”

Section: Future Perspectivesmentioning

confidence: 54%

“…To address this question, we evaluated GSTs performed in 515 patients, and found that BMI, fasting, peak, and nadir glucose levels correlated negatively with peak GH levels. 32 These data therefore suggest that lower GH cutpoints may be needed if the GST is to be used to reliably evaluate the GH reserve in hyperglycemic overweight/ obese patients, but requires further confirmation with larger prospective studies. This is clinically relevant because performing ITT in patients with diabetes and/or obesity can be challenging and may not be safe especially as large insulin doses are usually required to induce symptomatic hypoglycemia in these patients with underlying insulin resistance.…”

Section: Historical Perspective Of the Use Of Glucagon Stimulation Tementioning

confidence: 88%

“…35 In our recent study of 515 GSTs, the main side effects reported were nausea (ranging from 37.2 to 44.4 %), hunger, headaches, sleepiness, body chills, lightheadedness, and abdominal cramping that occurred mainly between 60 and 210 minutes, with rapid resolution by 240 minutes. 32 Like other GH stimulation tests, there are also limitations associated with the GST. The 3-or 4-hour GST is still longer than many other GH stimulation tests, and requires an intramuscular injection that may not appeal to some patients.…”

Section: 27mentioning

confidence: 99%

See 2 more Smart Citations

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Yuen

2014

US Endocrinology

View full text Add to dashboard Cite

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.

show abstract

Section: Future Perspectivesmentioning

confidence: 54%

Section: Historical Perspective Of the Use Of Glucagon Stimulation Tementioning

confidence: 88%

Section: 27mentioning

confidence: 99%

See 1 more Smart Citation

Glucagon Stimulation Testing in Adult Growth Hormone Deficiency A 2014 Update

Yuen

2014

US Endocrinology

View full text Add to dashboard Cite

show abstract

“…The GST was initially described as a 4-h test, but subsequent studies reduced the procedure time for 3 h, claiming that the majority of GH peaks occur between 120 and 180 min [9,10]. However, GH peaks after 3 h have been observed in up to one-third of patients in different studies, challenging the suggestion to shorten the procedure [11][12][13][14]. GST is usually performed with a fixed-dose of 1 mg (or 1.5 mg in patients over 90 kg) of glucagon administered via subcutaneous or intramuscular route [5,6,[10][11][12][13][14].…”

mentioning

confidence: 99%

“…However, GH peaks after 3 h have been observed in up to one-third of patients in different studies, challenging the suggestion to shorten the procedure [11][12][13][14]. GST is usually performed with a fixed-dose of 1 mg (or 1.5 mg in patients over 90 kg) of glucagon administered via subcutaneous or intramuscular route [5,6,[10][11][12][13][14]. Weight-based doses of glucagon in adults have been shown to promote higher cortisol and GH responses than fixed doses, resulting in different cutoff points for diagnosing SAI and GHD [13,14].…”

mentioning

confidence: 99%