PMID- 33728673
OWN - NLM
STAT- MEDLINE
DCOM- 20211027
LR  - 20211027
IS  - 1365-2265 (Electronic)
IS  - 0300-0664 (Linking)
VI  - 95
IP  - 1
DP  - 2021 Jul
TI  - Reducing adverse events associated with the glucagon stimulation test for the 
      assessment of growth hormone deficiency in adults with a high prevalence of 
      pituitary hormone deficiencies.
PG  - 125-133
LID - 10.1111/cen.14464 [doi]
AB  - DESIGN: A retrospective review of the adverse events (AEs) in 78 patients during 
      the glucagon stimulation test (GST) for the assessment of growth hormone 
      deficiency (GHD) before and after protocol amendments which aimed to reduce AEs 
      in a group of patients with a high prevalence of pituitary hormone deficiencies. 
      PATIENTS: Based on our observations of frequent AEs during the standard GST 
      protocol in an initial 25 patients (cohort 1), a modified protocol was introduced 
      to include the routine administration of 20 mg of hydrocortisone pre-GST in a 
      subsequent 53 patients (cohort 2). Post hoc analysis of the effect of 
      glucocorticoid dosing pre-GST on AEs was examined in those receiving <20 mg 
      hydrocortisone (group A, n = 19) vs >/=20 mg hydrocortisone (group B, n = 59). 
      MEASUREMENTS: AEs including hypotension, hypoglycaemia and nausea/vomiting. 
      RESULTS: Of the 78 patients undergoing the GST, 79% had >/=2 hormone deficiencies. 
      Rates of AEs were 41% vs 30% for hypotension, 60% vs 28% for hypoglycaemia 
      (p < .05) and 20% vs 13% for nausea/vomiting in cohort 1 compared with cohort 2, 
      respectively. Post hoc analysis revealed lower rates of AEs in those receiving 
      >/=20 mg hydrocortisone (group B) compared to those receiving <20 mg due to a 
      reduction in hypoglycaemic events (82% vs 26%, p < .001) and hypotension (50% vs 
      27%, p = .05). Similar numbers of patients in group A and group B met criteria 
      for GHD. CONCLUSIONS: In patients with a high prevalence of pituitary 
      deficiencies, a modified GST protocol of additional stress dose glucocorticoid 
      attenuated the frequency of AEs without appearing to compromise the performance 
      of the GST.
CI  - (c) 2021 John Wiley & Sons Ltd.
FAU - Gogna, Reetu
AU  - Gogna R
AUID- ORCID: 0000-0001-5704-6139
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
FAU - Jung, Caroline
AU  - Jung C
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
FAU - McLachlan, Kylie
AU  - McLachlan K
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
FAU - Krishnamurthy, Balasubramanian
AU  - Krishnamurthy B
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
AD  - St. Vincent's Institute, Fitzroy, Vic., Australia.
FAU - Hong, Alice
AU  - Hong A
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
FAU - Derbyshire, Maresa
AU  - Derbyshire M
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
FAU - Kiburg, Katerina V
AU  - Kiburg KV
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
AD  - St. Vincent's Institute, Fitzroy, Vic., Australia.
FAU - Zacharin, Margaret
AU  - Zacharin M
AD  - Hormone Research, Murdoch Children's Research Institute, Parkville, Vic., 
      Australia.
AD  - Department of Endocrinology, Royal Children's Hospital, Parkville, Vic., 
      Australia.
AD  - Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.
FAU - MacIsaac, Richard J
AU  - MacIsaac RJ
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
AD  - St. Vincent's Institute, Fitzroy, Vic., Australia.
FAU - Sachithanandan, Nirupa
AU  - Sachithanandan N
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
FAU - Caputo, Carmela
AU  - Caputo C
AD  - Department of Endocrinology & Diabetes, St. Vincent's Hospital Melbourne, 
      Fitzroy, Vic., Australia.
AD  - Department of Medicine, St Vincent's Hospital Melbourne, The University of 
      Melbourne, Fitzroy, Vic., Australia.
LA  - eng
PT  - Journal Article
DEP - 20210328
PL  - England
TA  - Clin Endocrinol (Oxf)
JT  - Clinical endocrinology
JID - 0346653
RN  - 12629-01-5 (Human Growth Hormone)
RN  - 9002-72-6 (Growth Hormone)
RN  - 9007-92-5 (Glucagon)
SB  - IM
MH  - Adult
MH  - *Dwarfism, Pituitary
MH  - Glucagon
MH  - Growth Hormone
MH  - *Human Growth Hormone
MH  - Humans
MH  - Prevalence
MH  - Retrospective Studies
OTO - NOTNLM
OT  - adverse events
OT  - glucagon stimulation test
OT  - growth hormone
EDAT- 2021/03/18 06:00
MHDA- 2021/10/28 06:00
CRDT- 2021/03/17 07:06
PHST- 2021/03/04 00:00 [revised]
PHST- 2020/12/19 00:00 [received]
PHST- 2021/03/14 00:00 [accepted]
PHST- 2021/03/18 06:00 [pubmed]
PHST- 2021/10/28 06:00 [medline]
PHST- 2021/03/17 07:06 [entrez]
AID - 10.1111/cen.14464 [doi]
PST - ppublish
SO  - Clin Endocrinol (Oxf). 2021 Jul;95(1):125-133. doi: 10.1111/cen.14464. Epub 2021 
      Mar 28.