Is the fear from insulin tolerance test in the evaluation of short stature justified?

Aaron Hanukoglu*, Regina Weisglass

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Among growth hormone (GH) provocative tests, insulin tolerance test (ITT) is considered a valuable test in children with short stature to diagnose GH deficiency. However, many pediatric endocrinologists are reluctant to perform it. We conducted a nationwide survey among all the pediatric endocrine clinics’ heads in Israel regarding their position on this issue. We found that the number of endocrine units performing ITT is almost nil. Sense of fear from severe hypoglycemia was a dominating cause for not performing ITT. We review the pros and cons of performing ITT versus other tests, especially glucagon test. Glucagon tolerance test is not considered the test of choice by some endocrinologists but recommended by others including in Israel. We also note the influence of a widely cited report published in 1992 (many times inaccurately) on endocrinologists’ views. Conclusion: A nationwide survey in Israel revealed a high rate of reluctance to perform ITT. The rationale behind this attitude was a sense of fear of performing the test by many endocrinologists. We discuss the preferences for choosing GH stimulation tests and the pros and cons of alternatives to ITT. The fear of not performing ITT was not always justified.What is Known:• ITT test is considered a gold standard in the evaluationof short stature to diagnose GH deficiency by many endocrinologists.What is New:• High reluctance rate found in Israel to performITT, prompted us to evaluate the attitudes of pediatric endocrinologists aroundthe world showing conflicting ideas.• The role of a single paper sometimes misquoted alsocontributed to these conflicting results.

Original languageEnglish
Pages (from-to)2867-2871
Number of pages5
JournalEuropean Journal of Pediatrics
Volume181
Issue number7
DOIs
StatePublished - Jul 2022

Keywords

  • Glucagon test
  • Growth hormone
  • Hypoglycemia
  • Insulin tolerance test
  • Short stature

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