A comparison of low‐dose ACTH, glucagon stimulation and insulin tolerance test in patients with pituitary disorders. (14th July 2014)

• Record Type: Journal Article
• Authors: Simsek, Y.; Karaca, Z.; Tanriverdi, F.; Unluhizarci, K.; Selcuklu, A.; Kelestimur, F.
• Is Part Of: Clinical endocrinology. Volume 82:Number 1(2015:Jan.)
• Page Start: 45
• Page End: 52
• Publication Date: 2014-07-14
• Subjects: Endocrinology -- Periodicals; 616.4005
• DOI: 10.1111/cen.12528
• Languages: English
• ISSNs: 0300-0664

Abstract

<abstract abstract-type="main" id="cen12528-abs-0001"> <title>Summary</title> <sec id="cen12528-sec-0001" sec-type="section"> <title>Context</title> <p>Diagnosis of secondary adrenal insufficiency and GH deficiency requires evaluation by dynamic stimulation tests in most cases. Although insulin tolerance test (ITT) is accepted as the gold‐standard test for the evaluation of both hypothalamo‐pituitary‐adrenal (HPA) and (GH)‐IGF‐1 axes, the test is cumbersome. In clinical practice, low‐dose adrenocorticotrophic hormone (ACTH) stimulation test is a sensitive, safe and easily applicable alternative to ITT. Although it takes more time, glucagon stimulation test (GST) is also a good alternative to ITT and can evaluate both axes.</p> </sec> <sec id="cen12528-sec-0002" sec-type="section"> <title>Objective</title> <p>The primary aim of this study was to compare the ITT, low‐dose ACTH and GSTs in the evaluation of HPA and GH‐IGF‐1 axes in patients with pituitary disorders and to evaluate the repeatability of all three tests.</p> </sec> <sec id="cen12528-sec-0003" sec-type="section"> <title>Design</title> <p>ITT, low‐dose ACTH and GSTs were performed in all 129 patients, and the tests were repeated in 66 of these patients.</p> </sec> <sec id="cen12528-sec-0004" sec-type="section"> <title>Setting</title> <p>Erciyes University Medical School, Department of Endocrinology.</p> </sec> <sec id="cen12528-sec-0005" sec-type="section"> <title>Patients or Other Participants</title> <p>One hundred and twenty‐nine adult patients (76 women, 53 men) with pituitary disorder were included in the study.</p> </sec> <sec id="cen12528-sec-0006" sec-type="section"> <title>Main Outcome Measure(s)</title> <p>The cortisol and GH responses of patients to dynamic tests.</p> </sec> <sec id="cen12528-sec-0007" sec-type="section"> <title>Results</title> <p>Peak cortisol levels obtained during ITT were significantly lower than the values obtained during both low‐dose ACTH and GSTs. Peak cortisol levels obtained during the GST were lower than those found during the low dose ACTH stimulation test. Peak GH responses were found to be higher in GST than in ITT. All three tests had good reproducibility.</p> </sec> <sec id="cen12528-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Any of 3 tests can be used in the evaluation of the HPA axis and either GST or the ITT can be used in the evaluation of the GH‐IGF‐1 axis but cut‐off levels for the insufficiency of HPA or GH‐IGF‐1 axis should be individualized for each test.</p> </sec> </abstract>