Endocrine Abstracts

Objectives: To collect qualitative and quantitative information on the burden of adult growth hormone deficiency (AGHD) diagnostic tests for the patient.

Methods: A survey was published on The Pituitary Foundation’s website and social media pages; respondents completed it online using SmartSurvey over period of two months (October-November 2021). 105 respondents took the survey, with 9 screened out after the first question because they had never taken an AGHD diagnostic test.

Results: Of the 96 respondents who completed the survey, 66 answered questions about the insulin tolerance test (ITT), 23 about the glucagon test, and 7 about the GHRH-arginine test. The ITT, whose mechanism of action depends on induced hypoglycaemia, presented both the widest variety of symptoms and, according to scores given by respondents, the most severe, with 9 of the 13 prompted symptoms experienced by the majority of patients who answered questions about it. When ITT patients were asked to rate the severity of the side effects they experienced on a scale of 1-5 (with 5 being the most severe), 5 symptoms − sweating, shakiness, fatigue, feeling dizzy, and feeling weak − had an average score of 3 or above (‘moderate’ or ‘severe’). Although the glucagon test and GHRH-arginine test were overall less burdensome, they still caused some prompted symptoms to be experienced by the majority of patients who underwent them. Only 44% of patients felt well-prepared for their test, and 34.4% did not think the information they received beforehand was thorough. The majority indicated that their test had impacted their daily life in the days following. Due to the difficulty of correctly managing hypoglycaemia and the level of training and experience required by the clinicians assigned to oversee the test, some patients experienced adverse events such as blood sugars taking longer than usual returning to normal, an unexpectedly strong reaction to the administration of insulin, and adrenal crisis. In some cases, patients needed to have their test repeated.

Conclusions: Taking any AGHD diagnostic test can be a very unpleasant experience for the patient, and adverse events are common; this is particularly true for the ITT, which is the most used test in the UK and the international ‘gold standard’. Due to the complexity and length of the test procedures, clinicians do not always appear to be confident when administering them. There is variability in patients’ understanding of these facts pre-test, as well as in clinical responses to any complications that occur.