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

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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 evaluation of short stature to diagnose GH deficiency by many endocrinologists.

What is New:

• High reluctance rate found in Israel to perform ITT, prompted us to evaluate the attitudes of pediatric endocrinologists around the world showing conflicting ideas.

• The role of a single paper sometimes misquoted also contributed to these conflicting results.

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Abbreviations

GH:

Growth hormone

ITT:

Insulin tolerance test

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Acknowledgements

We are grateful to all Pediatric Endocrinology Units heads in Medical Centers, pediatric endocrinologists and senior pediatricians performing the tests in HMO ambulatory services.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology, E. Wolfson Medical Center, Holon, Israel

    Aaron Hanukoglu & Regina Weisglass

  2. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Aaron Hanukoglu

Authors
  1. Aaron Hanukoglu
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  2. Regina Weisglass
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Contributions

A.H. planned and conducted the survey, wrote the manuscript and performed/supervised the ITTs over years in E Wolfson Medical Center. Registered nurse R.W. performed the ITTs with an accompanying physician.

Corresponding author

Correspondence to Aaron Hanukoglu.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Hanukoglu, A., Weisglass, R. Is the fear from insulin tolerance test in the evaluation of short stature justified?. Eur J Pediatr 181, 2867–2871 (2022). https://doi.org/10.1007/s00431-021-04364-w

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  • DOI: https://doi.org/10.1007/s00431-021-04364-w

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