Assessing adrenal function in primary care settings with a single sample subcutaneous glucagon test.
OBJECTIVE
To test the efficacy of the low-dose glucagon test in assessing adrenal gland function.


METHODS
Subcutaneous glucagon was used to assess the hypothalamo-pituitary-adrenal gland (HPA) axis in 215 healthy children. Concordance of this test with the low-dose intravenous ACTH test was established for 42 children. Glucagon testing was conducted for 150 minutes after subcutaneous glucagon administration and for 30 minutes after 1 microg intravenous ACTH.


RESULTS
Mean peak serum cortisol concentrations were 22.4 +/- 0.6 microg/dL (SEM) after subcutaneous glucagon and 20.0 +/- 0.6 microg/dL after intravenous ACTH. Specificity of 95% was found at peak cortisol concentrations of 9.5 and 12.5 microg/dL for the glucagon and ACTH tests, respectively. Concordance between the glucagon and ACTH tests was 90.5%.


CONCLUSIONS
The glucagon test was found to be as good a test of the HPA axis as the ACTH test and had a 90.5% concordance with it. The ease of performing the glucagon test, namely, obtaining a single sample of blood 150 minutes after the subcutaneous administration of glucagon, makes it a useful method of assessing the HPA axis in primary care settings.
Kappy
Michael S
MS
Children's Hospital, Denver, CO 80218, USA. kappy.michael@tchden.org
Drake
Amanda
A
Gao
Dexiang
D
Ratliff
Rebecca
R
D000293:Adolescent; D000307:Adrenal Gland Diseases / Q000378:metabolism / Q000503:physiopathology; D000311:Adrenal Glands / Q000378:metabolism*; D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004392:Dwarfism / Q000378:metabolism / Q000503:physiopathology; D005215:Fasting / Q000097:blood; D005260:Female; D005934:Glucagon / Q000008:administration & dosage* / Q000009:adverse effects; D006130:Growth Disorders / Q000378:metabolism / Q000503:physiopathology; D006593:Hexokinase; D006728:Hormones / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism; D007124:Immunoenzyme Techniques; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010900:Pituitary Diseases / Q000378:metabolism / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000378:metabolism; D011320:Primary Health Care; D011863:Radioimmunoassay; D012680:Sensitivity and Specificity; D013997:Time Factors
D001786:Blood Glucose; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D005934:Glucagon; D006593:Hexokinase; D006854:Hydrocortisone