title: The intramuscular glucagon stimulation test does not provide good discrimination between normal and inadequate ACTH reserve when used in the investigation of short healthy children.
abstract: OBJECTIVE
  Few studies have addressed the role of the glucagon stimulation test (GST) in evaluating the hypothalamic-pituitary-adrenal axis in children. We investigated the diagnostic value of the GST in evaluating the adrenocortical response in short healthy children.
  
  
  METHODS
  The GST was performed in 190 children investigated for short stature. A peak cortisol >500 nmol/l was considered a normal response. In the 45 (23.7%) with subnormal response, a 250-μg ACTH test was done.
  
  
  RESULTS
  The rate of subnormal adrenal response to GST was higher among boys (33.9 vs. 8.9%, p < 0.001) and among children ≥6 years than among younger children (32.7 vs. 18.4%, p < 0.02). Both mean basal and peak cortisol levels were higher in girls than in boys: 381 ± 165 vs. 319 ± 151 nmol/l (p = 0.003) and 741 ± 102 vs. 595 ± 208 nmol/l (p < 0.001), respectively. Peak cortisol on GST was associated with basal cortisol (r = 0.45, p < 0.001) but not with glucose nadir (r = -0.31, p = 0.67), peak GH (r = 0.069, p = 0.33) or BMI-SDS (r = -0.08, p = 0.28). Peak cortisol was >500 nmol/l in all the patients undergoing an ACTH stimulation test.
  
  
  CONCLUSIONS
  Since adrenal response to GST is age- and gender-related and the false-positive rate is high, its routine performance in healthy children warrants reconsideration.
authors.affiliation: The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Tenenbaum
authors.forename: Moshe
authors.initials: M
authors.lastname: Phillip
authors.forename: Liat
authors.initials: L
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000324:Adrenocorticotropic Hormone / Q000172:deficiency* / Q000378:metabolism*; D000375:Aging / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D005934:Glucagon / Q000008:administration & dosage; D006130:Growth Disorders / Q000175:diagnosis* / Q000378:metabolism*; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007273:Injections, Intramuscular; D008297:Male; D011627:Puberty / Q000378:metabolism; D015203:Reproducibility of Results; D012727:Sex Characteristics; D013268:Stimulation, Chemical
chemical_list: D019382:Human Growth Hormone; D000324:Adrenocorticotropic Hormone; D005934:Glucagon; D006854:Hydrocortisone