To compare the combined pegvisomant with the glucagon test to the insulin tolerance test and the glucagon test in diagnosing adult growth hormone and cortisol insufficiency.

Adults Growth Hormone Deficiency.

Pegvisomant 1 mg/kg injection 3 days before the glucagon test.

Pegvisomant

Regular insulin

Oregon Health & Science University

Pegvisomant With Glucagon Test to Assess for Adult Growth Hormone Deficiency

Effects of Pegvisomant-Priming With the Glucagon Stimulation Test in Assessing GH and Cortisol Reserve in Adults: a Randomized Proof-of-Concept Pilot Study

Presently, the insulin tolerance test (ITT) is regarded as the gold standard test in diagnosing adult GH deficiency but this test is difficult to perform in patients with diabetes mellitus, and contraindicated in the elderly, and in adults with seizures and ischemic heart disease. Glucagon test is the alternative test to the ITT but its accuracy and reliability is questionable in obesity and diabetes mellitus. Pegvisomant is a GH receptor blocker that increases GH secretion. When primed with glucagon, pegvisomant may enhance GH secretion by providing a stronger stimulus than glucagon alone. We plan to assess if by priming pegvisomant with glucagon will improve the accuracy of this test in diagnosing adult GH cortisol deficiency. Specifically, we will examine the characteristics of peak GH and cortisol levels, and ascertain the peak GH and cortisol levels in comparison to those generated using the ITT in diagnosing GH and cortisol deficiency.

We plan to assess the correlation between peak growth hormone and cortisol levels induced by the pegvisomant-glucagon test and BMI, fasting blood glucose levels, and evaluate the effects of pegvisomant on insulin-like growth factor-I bioactivity using the insulin-like growth factor-I kinase receptor activity assay.

Kevin Yuen

Associate Professor of Endocrinology

Oregon Health and Science University

Aarhus University Hospital

Subjects will undergo three ACTH stimulation test using a dose of 1 ug cotrosyn, 25 ug cortrosyn, 250ug cortrosyn and one Insulin tolerance test

Patients

Volunteers

Total

Sex: Female, Male

Region of Enrollment

Correlation of total cortisol levels of 1 ug, 25 ug and 250 ug cortrosyn stimulation test with Insulin Tolerance test is described in the outcome table

Every participant underwent three ACTH stimulation test and one Insulin tolerance test.

Patients + Volunteers

Pearson Correlation of the Total Cortisol Levels Between the ITT and CSTs

Correlation of free cortisol levels of 1 ug, 25 ug and 250 ug cortrosyn stimulation test with Insulin Tolerance test is described in the outcome table

Pearson Correlation of Free Cortisol Values During CSTs With ITT

Peak total cortisol values during cortrosyn stimulation tests(CST)

Peak Total Cortisol Values

Overall Study

Seenia Peechakara

Subjects will undergo an ACTH stimulation test using a dose of 1 ug cotrosyn
ACTH stimulation test: 1 ug cortrosyn dose
1 ug cortrosyn test: Subjects will undergo an ACTH test using a 1 ug dose cortrosyn

1ug Cortrosyn Dose Stimulation Test

Subjects will undergo an ACTH stimulation test using 250 ug cortrosyn dose
250 ug ACTH stimulation test: ACTH stimulation test will be done using 250 ug cortrosyn dose

250 ug Cortrosyn Dose Stimulation Test

Subjects will undergo an ACTH stimulation test using a 25 ug cortosyn dose
25 ug Cortrosyn stimulation test: ACTH stimulation test using a 25 ug cortrosyn dose

25 ug Cortrosyn Stimulation Test

Subjects will undergo an Insulin Tolerance Test
Insulin tolerance test: subjects will undergo an insulin tolerance test

acromegaly/epileptischer anfall

Pegvisomant With Glucagon Test to Assess for Adult Growth Hormone Deficiency

Value of 25 mcg Cortrosyn Stimulation Test

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