title: A comparison of low-dose ACTH, glucagon stimulation and insulin tolerance test in patients with pituitary disorders.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  ITT, low-dose ACTH and GSTs were performed in all 129 patients, and the tests were repeated in 66 of these patients.
  
  
  METHODS
  Erciyes University Medical School, Department of Endocrinology.
  
  
  METHODS
  One hundred and twenty-nine adult patients (76 women, 53 men) with pituitary disorder were included in the study.
  
  
  METHODS
  The cortisol and GH responses of patients to dynamic tests.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Endocrinology, Erciyes University Medical School, Kayseri, Turkey.
authors: Y
authors: Y
authors: Simsek
authors: Z
authors: Z
authors: Karaca
authors: F
authors: F
authors: Tanriverdi
authors: K
authors: K
authors: Unluhizarci
authors: A
authors: A
authors: Selcuklu
authors: F
authors: F
authors: Kelestimur
mesh_terms: D000324:Adrenocorticotropic Hormone; D000328:Adult; D005260:Female; D005934:Glucagon; D013006:Growth Hormone / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D061385:Insulins; D008297:Male; D008875:Middle Aged; D010900:Pituitary Diseases / Q000097:blood / Q000175:diagnosis*; D015203:Reproducibility of Results
chemical_list: D061385:Insulins; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D005934:Glucagon; D006854:Hydrocortisone