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Is lack of recombinant GH-releasing hormone in the United States a setback or time to consider glucagon testing for adult growth hormone deficiency
Journal of Clinical Endocrinology and Metabolism, 06/18/09

Yuen KCJ et al. - The ITT should remain the test of choice in diagnosing adult GHD. However, when the ITT is not desirable and recombinant GHRH remains unavailable in the United States, the authors recommend the alternative to the GHRH-ARG test to be the GST based on its reliability and availability. Nevertheless, further studies into alternative GH stimulation tests that are available in the United States, comparable and simpler to perform than the ITT in diagnosing adult GHD are still needed.

Exclusive Author Commentary
Kevin C. J. Yuen, 07/20/09

The discontinuation of recombinant GHRH in the US by EMD Serono has left many physicians that use the GHRH-arginine test a dilemma as to whether to consider the ITT in these patients. However, if the ITT is contraindicated or if facilities are not available for the ITT to be conducted safely, then a reliable alternative GH stimulation test is needed. We recommend to physicians to consider the glucagon stimulation test as the alternative test to the ITT. We acknowledge that the glucagon stimulation test has its drawbacks just like any other stimulation test, but at the present time, the advantages of considering this test include its availability, reproducibility, safety, and lack of influence by BMI, gender, or hypothalamic cause of GH deficiency. While our experience in the US on the glucagon stimulation is still relatively limited compared to our European counterparts, we thus recommend conducting the test over 4 hours with measurements every 30 min for serum GH and capillary blood glucose levels to ensure that delayed peak GH responses and late hypoglycemia are not missed. We hope that in the interim, another pharmaceutical company would take up where EMD Serono left off to manufacture recombinant GHRH so that the GHRH-ARG test can be utilized again in the US while we await the introduction of a comparable and simpler test to the ITT that is easily available, safe and reliable for diagnosing adult GH deficiency.

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