Startseite Medizin Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
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Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study

  • Ekkehard Werner Zöllner ORCID logo EMAIL logo , Carl J. Lombard und Annalise E. Zemlin ORCID logo
Veröffentlicht/Copyright: 6. September 2022
Journal of Pediatric Endocrinology and Metabolism
Aus der Zeitschrift Journal of Pediatric Endocrinology and Metabolism Band 35 Heft 10

Abstract

Objectives

The glucagon stimulation test (GST) is used for the simultaneous assessment of central adrenal insufficiency (CAI) and growth hormone deficiency. The new Roche cortisol II (C II) assay was recently introduced, confounding interpretation of the GST. The performance of the GST in diagnosing central adrenal insufficiency (CAI), utilising the C II assay, was therefore compared with that of the overnight metyrapone test (ONMTPT).

Methods

A diagnostic accuracy study was performed by retrospectively analysing folders and laboratory records of 25 children and adolescents investigated for hypopituitarism with the GST and the ONMTPT between September 2016 and December 2019. The peak serum cortisol (C) of the GST, the post-metyrapone serum 11-deoxycortisol and adrenocorticotropin levels of the ONMTPT were recorded. Diagnostic performance of the GST at a previously suggested cut-off of 374 nmol/L was evaluated.

Results

Seventeen boys and 8 girls, aged 1.7–16.3 years (median 7.3 years) were identified. The sensitivity of the post-GST C-level at 374 nmol/L was 0.40 (95% confidence interval [CI] 0.17–0.69), specificity 0.64 (95% CI 0.39–0.84), positive predictive value 0.44 (95% CI 0.19–0.73), negative predictive value 0.60 (95% CI 0.36–0.80), accuracy 0.54 (95% CI 0.35–0.72), positive likelihood ratio (+LR) 0.93 (95% CI 0.49–1.77) and negative LR 1.12 (95% CI 0.40–3.15). The area under the receiver of operating characteristics (ROC) curve was 0.379 (95% CI 0.142–0.615).

Conclusions

This study suggests that the GST at any C II cut-off cannot replace the ONMTPT as a diagnostic test for CAI in children. Findings should be confirmed in a larger study.

Keywords: adrenal; adrenal insufficiency; cortisol; glucagon; metyrapone; pituitary-adrenal function tests
Corresponding author: Ekkehard Werner Zöllner, Associate Professor, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, PO Box 241, 8000, Cape Town, South Africa, E-mail:

Acknowledgments

The authors express their gratitude to all the registrars and medical officers who performed the tests as well as the laboratory staff who analysed the samples.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent for the overnight metyrapone test is routinely obtained from all parents/children admitted for this test.

  5. Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies in accordance with the tenets of the Helsinki declaration. The study was approved by the Health Research Ethics Committee (HREC) of the Stellenbosch University (HREC number N21/03/031).

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Supplementary Material

The online version of this article offers the supplementary material (https://doi.org/10.1515/jpem-2022-0252).

Received: 2022-05-10
Accepted: 2022-08-16
Published Online: 2022-09-06
Published in Print: 2022-10-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Original Articles
  3. Newborn screening for propionic, methylmalonic acidemia and vitamin B12 deficiency. Analysis of 588,793 newborns
  4. Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review
  5. Study of the frequency and clinical features of maturity-onset diabetes in the young in the pediatric and adolescent diabetes population in Iran
  6. Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors
  7. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA
  8. Newborn screening and genetic variation of medium chain acyl-CoA dehydrogenase deficiency in the Chinese population
  9. Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
  10. Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity
  11. Biochemical indicators of euthyroid sick syndrome in critically ill children
  12. Short Communication
  13. Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes
  14. Case Reports
  15. Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism
  16. Three pediatric cases of symptomatic hyponatremia in Prader–Willi syndrome
  17. Identification of a novel mutation in FGFR1 gene in mother and daughter with Kallmann syndrome
  18. Exaggerated mini-puberty in a preterm girl: a case report and review of literature
  19. Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis
https://doi.org/10.1515/jpem-2022-0252
Schlagwörter für diesen Artikel
adrenal; adrenal insufficiency; cortisol; glucagon; metyrapone; pituitary-adrenal function tests

Artikel in diesem Heft

  1. Frontmatter
  2. Original Articles
  3. Newborn screening for propionic, methylmalonic acidemia and vitamin B12 deficiency. Analysis of 588,793 newborns
  4. Use of letrozole to augment height outcome in pubertal boys: a retrospective chart review
  5. Study of the frequency and clinical features of maturity-onset diabetes in the young in the pediatric and adolescent diabetes population in Iran
  6. Iatrogenic hyperthyroidism in primary congenital hypothyroidism: prevalence and predictive factors
  7. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA
  8. Newborn screening and genetic variation of medium chain acyl-CoA dehydrogenase deficiency in the Chinese population
  9. Performance of glucagon stimulation test in diagnosing central adrenal insufficiency in children when utilising the Roche Elecsys® cortisol II assay: a pilot study
  10. Effects and dose-response relationship of exercise training on cardiometabolic risk factors in children with obesity
  11. Biochemical indicators of euthyroid sick syndrome in critically ill children
  12. Short Communication
  13. Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes
  14. Case Reports
  15. Late onset Bartter syndrome: Bartter syndrome type 2 presenting with isolated nephrocalcinosis and high parathyroid hormone levels mimicking primary hyperparathyroidism
  16. Three pediatric cases of symptomatic hyponatremia in Prader–Willi syndrome
  17. Identification of a novel mutation in FGFR1 gene in mother and daughter with Kallmann syndrome
  18. Exaggerated mini-puberty in a preterm girl: a case report and review of literature
  19. Diabetic ketoacidosis masquerading behind alkalemia an undiagnosed or missed variant of diabetic ketoacidosis
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