Dynamic endocrine testing plays a vital role in diagnosing pituitary and hormonal disorders. The Harmonisation of Endocrine Dynamic Testing in Adults (HEDTA), a joint initiative of ESA/AACB/RCPA, provides protocols to standardize these procedures and ensure reliable interpretation of test results. A specialised endocrine testing facility is crucial, particularly for evaluating complex pituitary conditions. Close collaboration between clinicians and laboratory services is essential to ensure proper patient preparation, sample handling and provision of timely and accurate results. Additionally, understanding differences in immunoassay methodology can support clinical decision making.
At Sir Charles Gairdner Hospital, all requests for synacthen stimulation test (SST) are referred to the Endocrinology Registrar or Chemical Pathology Registrar at PathWest Laboratory Medicine. Morning bookings are made for referrals from Specialists and ideally patients not on corticosteroid therapy. The Endocrinology Resident Medical Officer (RMO) supervises the testing.
Glucagon Stimulation Test (GST) is the investigation of choice for assessment of adult growth hormone deficiency. This is well tolerated and risk of hypoglycaemia is low. This procedure is supervised by the Endocrinology RMO in the Immunology Testing Unit. Insulin tolerance test is rarely performed.
The challenges and pitfalls associated with SST and GST will be highlighted in case-based discussion.