What is it about?

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 est 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.

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Why is it important?

Due to its low side effects and the possibility of coupled dosing with GH, the glucagon test is a valid alternative for a contraindication to the insulin hypoglycaemia test. It also allows evaluation of early hypothalamic-pituitary disorders without response variability, which remains a valuable advantage over synacthen test.

Perspectives

ROC curve analysis showed that the best diagnostic accuracy was obtained with a peak cortisol cutoff 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.

Taieb Ach
Hospital University Farhat Hached Sousse Tunisia

Read the Original

This page is a summary of: Cortisol cut-points for the glucagon stimulation test in the evaluation of hypothalamic pituitary adrenal axis, Endocrine Journal, January 2018, Japan Endocrine Society,
DOI: 10.1507/endocrj.ej18-0147.
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