The Accuracy of the Glucagon Test Compared to the Insulin Tolerance Test in the Diagnosis of Adrenal Insufficiency in Young Children with Growth Hormone Deficiency

Iorgi, Natascia Di; Napoli, Flavia; Allegri, Anna Elsa Maria; Secco, Andrea; Calandra, Erika; Calcagno, Annalisa; Frassinetti, Costanza; Ghezzi, Michele; Ambrosini, Linda; Parodi, Stefano; Gastaldi, Roberto; Loche, Sandro; Maghnie, Mohamad

doi:10.1210/jc.2009-2697

Cited by 40 publications

(39 citation statements)

References 42 publications

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“…In a recently reported study, GH therapy was even found to be associated with acute adrenal insufficiency and death [5]. Thus, assessment of the hypothalamic-pituitary-adrenal (HPA) axis at the time of evaluation for GH deficiency is often recommended [6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, water may be given freely during the test. Thus, in our institute as well as other pediatric centers [7,13], this test has become much more popular in recent years, especially for use in children. Despite the frequency with which the GST is carried out in children, to date there have been few pediatric studies designed to evaluate the accuracy and specificity of the test in assessing the HPA axis in children.…”

Section: Introductionmentioning

confidence: 99%

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The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

2014

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Background/Aims: Few studies have addressed the role of the glucagon stimulation test (GST) in evaluating the hypothalamic-pituitary-adrenal axis in children. We investigated the diagnostic value of the GST in evaluating the adrenocortical response in short healthy children. Methods: The GST was performed in 190 children investigated for short stature. A peak cortisol >500 nmol/l was considered a normal response. In the 45 (23.7%) with subnormal response, a 250-μg ACTH test was done. Results: The rate of subnormal adrenal response to GST was higher among boys (33.9 vs. 8.9%, p < 0.001) and among children ≥6 years than among younger children (32.7 vs. 18.4%, p < 0.02). Both mean basal and peak cortisol levels were higher in girls than in boys: 381 ± 165 vs. 319 ± 151 nmol/l (p = 0.003) and 741 ± 102 vs. 595 ± 208 nmol/l (p < 0.001), respectively. Peak cortisol on GST was associated with basal cortisol (r = 0.45, p < 0.001) but not with glucose nadir (r = -0.31, p = 0.67), peak GH (r = 0.069, p = 0.33) or BMI-SDS (r = -0.08, p = 0.28). Peak cortisol was >500 nmol/l in all the patients undergoing an ACTH stimulation test. Conclusions: Since adrenal response to GST is age- and gender-related and the false-positive rate is high, its routine performance in healthy children warrants reconsideration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

2014

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“…In agreement, we used ITT to evaluate the HPA axis in GHD children. Although we showed good correlation between morning serum cortisol and its peak during ITT, it is widely demonstrated that the baseline morning serum cortisol concentration has limited predictive power in differentiating between normal and impaired HPA function [27,28,34]. In agreement with these observations, our data showed that morning cortisol evaluation cannot be considered a reliable indicator of AI in children with GHD because the capacity of morning cortisol to diagnose AI differs from that of the cortisol peak during ITT; that is to say, with the cortisol peak we can diagnose a percentage of potential AI that cannot be diagnosed with morning cortisol.…”

Section: Discussionmentioning

confidence: 66%

Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

Ciresi

Radellini

Vigneri

et al. 2017

J Endocrinol Invest

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“…They suggested cortisol cutoff of 16 µg/dL for best pair of sensitivity and specificity (20). Another cortisol cutoff was suggested at 14.6 compared to 20 µg/dL for ITT (21).…”

Section: Dynamic Testing Of Hpa Axismentioning

confidence: 99%

Recovery of steroid induced adrenal insufficiency

Younes

2017

Transl. Pediatr

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Secondary adrenal insufficiency can result from insufficient stimulation of the adrenal glands due to inadequate secretion or synthesis of adrenocorticotropic hormone (ACTH). This can be caused by hypopituitarism, central nervous system injury (tumors, radiation, and surgery) or long-term glucocorticoid therapy. Glucocorticoids were introduced in the 1950s, and have been used for their anti-inflammatory and other pharmacological effects, and also as replacement therapy for adrenal insufficiency. However, chronic glucocorticoid use may lead to suppression of the hypothalamic pituitary adrenal axis through negative feedback. This may lead to secondary adrenal insufficiency. Typically, the hypothalamic pituitary adrenal axis recovers after cessation of glucocorticoids, but the timing of recovery can be variable and can take anywhere from 6-12 months. Understanding the effect of exogenous glucocorticoids on the hypothalamic pituitary adrenal axis, recovery of the axis, and tests used to assess the recovery, are crucial to avoid prescribing unnecessary steroid replacement or missing a critical diagnosis with detrimental consequences.

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The Accuracy of the Glucagon Test Compared to the Insulin Tolerance Test in the Diagnosis of Adrenal Insufficiency in Young Children with Growth Hormone Deficiency

Abstract: This study shows that glucagon is an accurate and safe diagnostic test for adrenal function in young children who are at risk for adrenal insufficiency.

Cited by 40 publications

References 42 publications

The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

The Intramuscular Glucagon Stimulation Test Does Not Provide Good Discrimination between Normal and Inadequate ACTH Reserve When Used in the Investigation of Short Healthy Children

Correlation between adrenal function, growth hormone secretion, and insulin sensitivity in children with idiopathic growth hormone deficiency

Recovery of steroid induced adrenal insufficiency

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