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Weight-based dosing regimen for glucagon stimulation test more reliable than fixed-dose

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ENDO 2011

BOSTON — Using a weight-based regimen of the glucagon stimulation test may be more favorable than using a fixed-dose regimen in evaluating the growth hormone reserve and the hypothalamic-pituitary-adrenal axis in adults, according to research presented here.

Researchers at Oregon Health & Science University and Allegheny General Hospital in Pittsburgh compared the two regimens of the glucagon stimulation test in assessing growth hormone reserve and the hypothalamic-pituitary-adrenal (HPA) axis. Adults with suspected GH deficiency and adrenal insufficiency were studied. Those patients were closely matched for age, sex, BMI and fasting glucose levels.

The fixed-dose regimen included the intramuscular administration of 1 mg of glucagon for patients who weighed 90 kg or less and 1.5 mg of glucagon for patients who weighed more than 90 kg. The weight-based regimen included the intramuscular administration of 0.03 mg/kg of glucagon. Forty-two patients underwent the fixed-dose regimen and 44 patients underwent the weight-based regimen. Blood was sampled at baseline and every 30 minutes for 240 minutes during the glucagon stimulation test.

According to Kevin Yuen, MD, an endocrinologist at Oregon Health & Science University, both regimens were safe and well tolerated. The data demonstrated:

• Peak glucose occurred 84% between 60 to 150 minutes for the weight-based regimen and 90% between 30 to 60 minutes for the fixed dose regimen.
• Peak GH occurred 98% between 180 to 240 minutes for the weight-based regimen and 71% between 90 to 150 minutes for the fixed-dose regimen.
• Peak cortisol was 82% between 210 to 240 minutes for the weight-based regimen and 69% between 150 to 240 minutes for the fixed-dose regimen.

“Weight-based dosing generated higher peak cortisol levels and larger changes from baseline to peak GH and cortisol levels, suggesting that the weight-based dosing may be the more effective regimen in inducing GH and cortisol release than the fixed-dose regimen,” Yuen said during an oral abstract presentation. “Thus, the weight-based dosing may be more reliable than the fixed-dose dosing regimen in evaluating the GH reserve and the HPA axis in adults with suspected GH deficiency and adrenal insufficiency.”

The researchers said these findings, however, will require further classification with a large, prospective, comparative clinical trial. – by Emily Shafer

Disclosure: Dr. Yuen reports no relevant financial disclosures.

For more information:

• Yuen K. #OR16-3. Presented at: The Endocrine Society 93rd Annual Meeting & Expo; June 4-7, 2011; Boston.

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