The process involves glucagon administration, which prompts GH release from the anterior pituitary gland. These samples are analyzed to measure GH, glucose, and insulin levels. The peak GH level is determined from the collected samples, and the results are interpreted based on the specific laboratory reference range.

It should be noted that the glucagon stimulation test is not devoid of potential side effects, and patients may experience nausea, vomiting, or dizziness during the test. In addition, this test may not be appropriate for patients with certain health conditions, such as pheochromocytoma, due to the potential risk of blood pressure instability.

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education. Please log in again. The login page will open in a new tab. After logging in you can close it and return to this page.

My Endo Consult Accessibility Statement. We firmly believe that the internet should be available and accessible to anyone, and are committed to providing a website that is accessible to the widest possible audience, regardless of circumstance and ability.

These guidelines explain how to make web content accessible to people with a wide array of disabilities. Complying with those guidelines helps us ensure that the website is accessible to all people: blind people, people with motor impairments, visual impairment, cognitive disabilities, and more.

This website utilizes various technologies that are meant to make it as accessible as possible at all times. Additionally, the website utilizes an AI-based application that runs in the background and optimizes its accessibility level constantly. As soon as a user with a screen-reader enters your site, they immediately receive a prompt to enter the Screen-Reader Profile so they can browse and operate your site effectively.

In this process, we provide screen-readers with meaningful data using the ARIA set of attributes. For example, we provide accurate form labels; descriptions for actionable icons social media icons, search icons, cart icons, etc.

It will also extract texts that are embedded within the image, using an OCR optical character recognition technology. Screen-reader users also get automatic announcements to turn the Screen-reader mode on as soon as they enter the website. The background process also handles triggered popups by moving the keyboard focus towards them as soon as they appear, and not allow the focus drift outside of it.

We aim to support the widest array of browsers and assistive technologies as possible, so our users can choose the best fitting tools for them, with as few limitations as possible.

Despite our very best efforts to allow anybody to adjust the website to their needs, there may still be pages or sections that are not fully accessible, are in the process of becoming accessible, or are lacking an adequate technological solution to make them accessible.

Still, we are continually improving our accessibility, adding, updating and improving its options and features, and developing and adopting new technologies. All this is meant to reach the optimal level of accessibility, following technological advancements.

For any assistance, please reach out to admin myendoconsult. Glucagon Stimulation Test. Share 0. Tweet 0. Pin 0. Indications for the Glucagon Stimulation Test To evaluate patients who are suspected to have growth hormone GH deficiency.

Test Requirements Pre-Test Requirements: Patients should not consume anything Nil per os, NPO except water after midnight and during the test.

Physiology of Growth Hormone and Glucagon Action Biological Role and Functionality Glucagon, an important peptide hormone produced by alpha cells of the pancreas, plays a pivotal role in growth hormone GH regulation. Growth Hormone Stimulation Test Procedure The glucagon stimulation test serves as a diagnostic procedure used to identify GH deficiency in suspected individuals.

Interpretation of the Growth Hormone Stimulation Test The peak GH level is determined from the collected samples, and the results are interpreted based on the specific laboratory reference range.

Trending Congenital Leptin Deficiency Mechanism. J Clin Endocrinol Metab — Hosseinnezhad A, Black RM, Aeddula NR, Adhikari D, Trivedi N Glucagon-Induced Pheochromocytoma Crisis. Endocrine Practice e51—e54 Conceição FL, da Costa e Silva A, Leal Costa AJ, Vaisman M Glucagon stimulation test for the diagnosis of GH deficiency in adults.

J Endocrinol Invest — Kindly Let Us Know If This Was helpful? Growth hormone deficiency GHD in adults is a recognised clinical syndrome and its diagnosis is established through GH stimulation testing. The decision to perform GH stimulation testing should be based on clinical findings, medical history and using the appropriate GH stimulation test to obtain biochemical evidence.

The insulin tolerance test ITT remains the diagnostic test of choice, but this test is labour intensive, contraindicated in the elderly and in adults with seizure disorders and ischaemic heart disease, can be unpleasant for the patient, and is potentially hazardous. The glucagon stimulation test GST in recent years has been increasingly used as the alternative test to the ITT in the US and Europe because of its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GHD, and relatively few contraindications.

In the article, we discuss our recommendations in performing this test, the potential drawbacks in conducting and caveats in interpreting this test, and its future perspectives. Growth hormone, glucagon, insulin tolerance test, growth hormone releasing hormone plus arginine, diagnosis, adult growth hormone deficiency.

Growth hormone deficiency GHD in adults is characterised by alterations in body composition, carbohydrate and lipid metabolism, bone mineral density, cardiovascular risk profile and quality of life. Current published guidelines recommend evaluation of adult GHD to be based on clinical findings, medical history and using the appropriate GH stimulation test for biochemical confirmation, 7,8 with the exception of patients with three or more pituitary hormone deficiencies and low serum IGF-I levels.

The insulin tolerance test ITT is generally considered the gold standard test for evaluation of GH deficiency and has been endorsed by different consensus guidelines, 7,8,10 but this test is labour intensive, may be unpleasant for some patients, has potential risks, and is contraindicated in elderly patients and in patients with seizure disorders and ischaemic heart disease.

Thus, there remains a real unmet medical need for an alternative test to the ITT that is safe yet reliable. For this reason, other dynamic tests have been proposed such as arginine ARG , combined GH releasing hormone plus ARG GHRH-ARG , levodopa L-DOPA in spite of data indicating poor performance of some of these tests for evaluation of adult GHD.

Following the publication of several validation studies 11, and recommendations from current consensus guidelines, 7,8,10 the GHRH-ARG test has in recent years emerged as the best and most reliable alternative GH stimulation test to the ITT in diagnosing adult GHD.

However, when EMD Serono, Inc decided to discontinue the manufacture of recombinant GHRH Geref ® in the US in July , 17 this inevitably left a significant gap for an alternative reliable test for evaluation of patients suspected to have GHD in place of the GHRH-ARG test.

This is particularly important for endocrinologists in the US who are not comfortable or do not have the necessary logistical or staff support to conduct ITTs in their office or patients who have contraindications to hypoglycaemia in whom the ITT would be inappropriate.

With the lack of reliable GH stimulation tests available in the US, we recommended the glucagon stimulation test GST as the alternative test to the ITT for diagnosing adult GHD based on its availability, reproducibility, safety, lack of influence by gender and hypothalamic cause of GHD, and relatively few contraindications.

addressed the question of whether there were regional differences in the use of different biochemical tests to diagnose adult GHD in six large European countries and the US.

However, the unavailability of the GHRH-ARG test in the US since has resulted in the GST being more frequently considered as the alternative test to the ITT. The use of the GST for the assessment of GH reserve was first described in by Mitchell et al.

Some of the hypothesised mechanisms include the glycaemic fluctuations during the test where blood glucose levels increase initially before decreasing later in the test, 24 the generation of a peptidyl fragment associated with the GH- and ACTH-releasing activity 25 and the induction of norepinephrine secretion in stimulating GH release via α-receptors.

The three studies utilising the GST by Gomez et al. The first two studies 19,27 were prospective studies that compared the diagnostic characteristics of GST to ITT and included a control group which was matched for age and sex in both studies and for body mass index BMI in one study.

demonstrated that peak GH levels were not affected by age in either the control or patient group, and that there were no gender differences. was a retrospective study that revealed an optimal peak GH cut-off value of 2. Nevertheless, these 19,23,27 and previous studies 20—22,29 did not specifically evaluate patients with glucose intolerance and frank diabetes, and for this reason, the characteristic of the GST and its reliability in testing for GHD in this population remains unclear.

The diagnosis of adult GHD has proved to be challenging because of the lack of a single biological endpoint such as growth failure, and therefore, the confirmation of adult GHD largely depends on biochemical provocative testing.

Clearly, there is no ideal stimulation test and we recommend that the decision to embark on a stimulation test to diagnose adult GHD must factor in the appropriate clinical context of each individual patient together with the number of pituitary hormone deficiencies plus serum IGF-I level, 9 the validity of the chosen test and its appropriate cut-off limits, the sensitivity of the GH assay, and the availability of local resources and expertise.

The GST is a simple and safe test to perform Table 1. Glucagon is readily accessible because it is widely available for treating hypoglycaemic episodes in patients with diabetes. Glucagon appears to be well tolerated and is only relatively contraindicated in patients with malnourishment or who have not eaten for more than 48 hours due to concern of prolonged hypoglycaemia and those with pheochromocytoma in whom a significant exacerbation of blood pressure may be observed.

In a study by Orme et al. is the largest study that assessed patients with hypothalamic-pituitary disease whom had undergone the GST, and they reported that the test could be shortened by omitting the minute blood sample.

This also allows the monitoring for late hypoglycaemia, although truly low blood glucose levels are not common. Like other GH stimulation tests, there are also limitations associated with the GST.

The three- or four-hour GST is still longer than many other GH stimulation tests, and requires an intramuscular injection which may not appeal to some patients.

However, as there is a relationship between peak GH response to GHRH-ARG stimulation and ambient glucose levels, 35 it is unclear whether hyperglycaemia may play a part in influencing the peak GH response to glucagon stimulation.

Furthermore, no peak GH responses have been studied using the GST in normal controls over the age of 70 years and none of the previous studies included patients with frank diabetes. Therefore, it is not known whether testing using the GST in subjects with diabetes is valid.

Hence, caution should be exercised when interpreting normal GST results in the patients with diabetes. If the suspicion of GHD remains high in these patients, it is reasonable to consider using a second GH stimulation test. Other provocative tests that have been proposed include ARG alone and GH secretagogues.

If your child has any medical problems, particularly allergies, please tell the doctors about these. Please also bring in any medications your child is currently taking.

Your child will need to have a cannula thin, plastic tube inserted into a vein, so that blood samples can be taken more easily. A nurse will apply some local anaesthetic cream first so that the skin is numb. If your child is over five years old, they may like to have a cold numbing spray before the needle.

Your child will not be allowed to eat anything during the test, and will only be allowed to drink water. It is important to follow these instructions, otherwise the test will need to be stopped and repeated at another time.

The test starts when the nurse takes the first small sample of blood from the cannula, and gives your child an injection of glucagon into his or her thigh. This injection raises their blood sugar levels. This will continue for three hours before the final test is taken. During this time, your child will need to stay on the ward so that the nurses can monitor them.

Once the nurses have taken the final blood sample, your child will be able to eat and drink as usual. The nurses will give them a choice of food and drink, to replenish their sugar supplies.

Your child will need to stay on the ward for an hour after eating so that the nurses can continue to check the blood sugar level. Once it has returned to normal, the nurses will remove the cannula and you will be able to take your child home.

The nurses will stop the test if they are at all concerned about your child. Your child may feel tired and miserable during the test because he or she will not be allowed to eat as usual.