Adieu, Glucagon Stimulation Test

In the olden days, there were a few dynamic tests to diagnose pheo. In those days, none of the biochemical tests and imaging methods that we take for granted today was available. If you and I feel frustrated now over diagnosing a pheo, imagine how people felt then!

The glucagon stimulation test was one of the dynamic tests invented in those days. Glucagon is a hormone produced by the alpha cells in the pancreatic islets (insulin is by the beta cells in the same islets). Glucagon has many functions. The main one is to increase blood glucose levels (that’s why it is used to treat hypoglycemia). It also stimulates the heart and increases blood pressure. At the beginning, increase of blood pressure after glucagon was used to diagnose pheo; later, the test changed to increase of norepinephrine after glucagon.

The glucagon stimulation test began to fade away after better tests for pheo were discovered. It is seldom used in the last 20 years. Whether it has any unique value in modern-day medicine, however, is never satisfactorily answered. I have been asked by my own patients about the glucagon stimulation test and some patients wonder if the test can uncover a hidden pheo. A recent study systemically examined the body’s response to glucagon and largely settled the question.

This study shows that norepinephrine increases dramatically after glucagon in only about ¼ to ½ of pheo patients. In the other ½ to ¾ of pheo patients, the increase in norepinephrine levels is too small to have any diagnostic value. In other words, it is not sensitive enough. In the subgroup of patients who have borderline metanephrine results and need further testing, the performance of glucagon stimulation test is similar.

The glucagon stimulation test is not without risks. A few patients had hypertensive crisis. One patient developed visual problems that eventually recovered in a few months.

This study, along with a few others, clearly demonstrates that the glucagon stimulation test has no place in diagnosing pheo in modern medicine. We should not use it any more for the purpose of diagnosing pheo.

Dr. Pheo