The metabolic and hormonal response to glucagon

Goodwin, Peter M.; Capildeo, Rudy; Harrop, J. S.; Marks, Vincent; Rose, F. Clifford

doi:10.1016/0022-510x(76)90009-5

Cited by 21 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four out of the six subjects showed a response of less than 500 nmol/l during the GST, the usual level at which we would normally prescribe glucocorticoid replacement in our patients. Great variability between the cortisol responses to subcutaneous glucagon has been noted previously in normal subjects (Eddy et al, 1970;Spathis et al, 1974;Goodwin et al, 1976). This suggests that the subcutaneous GST is an inconsistent test of pituitary ACTH reserve and may be insufficiently reliable for use in patients.…”

Section: Discussionmentioning

confidence: 89%

Comparison of the Acth and Cortisol Responses to Provocative Testing With Glucagon and Insulin Hypoglycaemia in Normal Subjects

Littley¹,

Gibson²,

White³

et al. 1989

Clinical Endocrinology

View full text Add to dashboard Cite

The glucagon stimulation test (GST) is often used to assess pituitary ACTH reserve, particularly when other tests are contra-indicated. In a preliminary investigation, in patients with pituitary disease, we failed to demonstrate the ACTH dependence of the cortisol response. We have therefore compared the ACTH, cortisol and glucose responses to glucagon (1 mg s.c.), insulin (0.2 U/kg i.v., ITT) and placebo in six healthy male volunteers, sampling every 10 min for 6 h. During the GST, mean +/- SD serum cortisol rose from 256 +/- 80 nmol/l to a peak of 481 +/- 164 nmol/l (range 289-717 nmol/l, P less than 0.01) in comparison with 280 +/- 81 nmol/l to 602 +/- 110 nmol/l (range 493-742 nmol/l) during the ITT (P less than 0.002). The mean peak cortisol levels achieved in the two tests did not differ significantly. In the GST, plasma ACTH rose from a mean basal value of 10.9 +/- 16.6 ng/l to a mean peak level of 123 +/- 76 ng/l (P less than 0.02) (ACTH ng/l x 0.225 = pmol/l). The corresponding values in the ITT were 7.1 +/- 16.2 ng/l and 263 +/- 91 ng/l (P less than 0.001). The mean peak ACTH level was significantly greater during the ITT (P less than 0.05). Thus the cortisol response was ACTH dependent in both the GST and the ITT in normal subjects. Furthermore, the ACTH response was of sufficient duration to be detected by the usual procedure of sampling every 30 min.(ABSTRACT TRUNCATED AT 250 WORDS)

show abstract

Section: Discussionmentioning

confidence: 89%

Comparison of the Acth and Cortisol Responses to Provocative Testing With Glucagon and Insulin Hypoglycaemia in Normal Subjects

Littley¹,

Gibson²,

White³

et al. 1989

Clinical Endocrinology

View full text Add to dashboard Cite

show abstract

“…Another possible mechanism for glucagon induced GH release is via noradrenaline secretion. Glucagon has been shown to induce noradrenaline release in healthy volunteers (Goodwin et al . 1976).…”

Section: Discussionmentioning

confidence: 99%

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

Leong

Walker

Martin

et al. 2001

Clinical Endocrinology

132

109

View full text Add to dashboard Cite

show abstract

“…Another mechanism by which glucagon may possibly stimulate cortisol secretion is via activation of the central noradrenergic pathways [19]. Although glucagon has been shown by Goodwin et al to induce noradrenaline release in healthy subjects who finds two peaks of norepinephrine preceding the peaks of cortisol in the 30th minute and the 150th minute [20]. This release by itself facilitates GH secretion and helps in the secretion of cortisol [10,18].…”

Section: Discussionmentioning

confidence: 99%

Cortisol cut-points for the glucagon stimulation test in the evaluation of hypothalamic pituitary adrenal axis

et al. 2018

View full text Add to dashboard Cite

Diagnosis of adrenal insufficiency requires evaluation by dynamic stimulation tests. The insulin tolerance test (ITT) is accepted as the gold-standard test for the evaluation of hypothalamo-pituitary-adrenal (HPA) axis but the test is unpleasant and dangerous. Although it takes more time, glucagon stimulation test (GST) is a good alternative to ITT. The primary aim of this study was to compare the ITT and GSTs in the evaluation of HPA axe in patients with pituitary disorders. We conducted a prospective study in which ITT and GST were performed within 7 days in 81 patients. Serum cortisol was measured. We divided our population in Group 1 (G1): Adrenal Insufficiency (Peak cortisol under ITT <200 ng/mL) and Group 2 (G2): normal response (Peak cortisol under ITT >200 ng/mL). Receiver-operating characteristic (ROC) analysis was performed to identify the thresholds for GST. The mean peak of cortisol under GST was not significantly different from that obtained after ITT in the whole cohort (182.67 ± 89.07 ng/mL vs. 179.75 ± 79.01 ng/mL), and it was significantly reduced in patients of G1 (p < 10). ROC curve analysis showed that the best diagnostic accuracy was obtained with a peak cortisol cut-off to GST of 167 ng/mL (sensitivity, 89%; specificity, 79%). Using this cut-off, 86.4% of the patients were correctly classified. In our prospective series, GST is a potential accurate and safe alternative test for the assessment HPA. Test-specific cut-offs should be applied to avoid misinterpretation.

show abstract

The metabolic and hormonal response to glucagon

Cited by 21 publications

References 16 publications

Comparison of the Acth and Cortisol Responses to Provocative Testing With Glucagon and Insulin Hypoglycaemia in Normal Subjects

Comparison of the Acth and Cortisol Responses to Provocative Testing With Glucagon and Insulin Hypoglycaemia in Normal Subjects

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

Cortisol cut-points for the glucagon stimulation test in the evaluation of hypothalamic pituitary adrenal axis

Contact Info

Product

Resources

About