An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic-pituitary disease

Clin Endocrinol (Oxf). 2001 Apr;54(4):463-8. doi: 10.1046/j.1365-2265.2001.01169.x.


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.

Design and patients: 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.

MeSH terms

  • Acromegaly / blood
  • Adenoma / blood
  • Adolescent
  • Adrenocorticotropic Hormone / metabolism*
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / analysis
  • Child
  • Female
  • Glucagon*
  • Growth Hormone / blood*
  • Humans
  • Hydrocortisone / blood
  • Hypothalamic Diseases / blood
  • Hypothalamic Diseases / diagnosis*
  • Injections, Subcutaneous
  • Male
  • Medical Audit*
  • Middle Aged
  • Pituitary Diseases / blood
  • Pituitary Diseases / diagnosis*
  • Pituitary Function Tests / statistics & numerical data
  • Pituitary Neoplasms / blood
  • Sensitivity and Specificity
  • Stimulation, Chemical
  • Time Factors


  • Blood Glucose
  • Adrenocorticotropic Hormone
  • Growth Hormone
  • Glucagon
  • Hydrocortisone