title: An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic-pituitary disease.
abstract: OBJECTIVE
  The insulin tolerance test (ITT) is usually regarded as the 'gold standard' for the assessment of the hypothalamic-pituitary axis (growth hormone (GH) and ACTH) but must be used with caution and is contra-indicated in certain groups of patients. The glucagon stimulation test (GST) has previously been shown to be a good alternative when the ITT is contra-indicated and like the ITT stimulates both GH and ACTH secretion. There is however limited data on the use of the GST in patients with hypothalamic-pituitary disease.
  
  
  METHODS
  An audit of 500 GST was performed in 374 patients with hypothalamic-pituitary disease. Glucagon was administered via the subcutaneous route and bloods were taken at times 0 90 120 150 180 210 and 240 minutes.
  
  
  RESULTS
  In the vast majority peak GH (84.4%) and cortisol (93%) responses occurred between 120 and 180 minutes Little information was obtained from the 240 minute sample. The medical supervision required was minimal and the side-effects encountered during this test were mild; 20% of the tests were associated with nausea occasionally with vomiting sweating or headaches. Four patients fainted but recovered quickly.
  
  
  CONCLUSIONS
  This large audit has shown that the glucose stimulation test is well tolerated and can easily be performed in an out-patient setting with minimal medical supervision. The 240 minute sample added little additional information and could be omitted.
authors.affiliation: Diabetes Centre, Whiston Hospital, Warrington Road, Prescot, Merseyside L35 5DR, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Leong
authors.forename: A B
authors.initials: AB
authors.lastname: Walker
authors.forename: I
authors.initials: I
authors.lastname: Martin
authors.forename: D
authors.initials: D
authors.lastname: Wile
authors.forename: J
authors.initials: J
authors.lastname: Wilding
authors.forename: I A
authors.initials: IA
authors.lastname: MacFarlane
mesh_terms: D000172:Acromegaly / Q000097:blood; D000236:Adenoma / Q000097:blood; D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D005260:Female; D005934:Glucagon; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007027:Hypothalamic Diseases / Q000097:blood / Q000175:diagnosis*; D007279:Injections, Subcutaneous; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010900:Pituitary Diseases / Q000097:blood / Q000175:diagnosis*; D010901:Pituitary Function Tests / Q000706:statistics & numerical data; D010911:Pituitary Neoplasms / Q000097:blood; D012680:Sensitivity and Specificity; D013268:Stimulation, Chemical; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D005934:Glucagon; D006854:Hydrocortisone