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Evaluation and Investigation of Pituitary Disease
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
GH deficiency and ACTH hyposecretion can be demonstrated by an inadequate response to the insulin tolerance test or glucagon stimulation test. The glucagon stimulation test can be performed when insulin is contraindicated (adrenal insufficiency, coronary artery disease, or seizure disorders). Basal LH, FSH, and sex hormone levels can be measured and are sufficient to establish the diagnosis of hypogonadism. The GnRH stimulation test is now rarely used. Thyroid function tests (TSH, T4, T3) can confirm secondary hypothyroidism, and the TRH test is generally not required.
Systemic Response to Surgery and Shock
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Sympatho-pancreas:Reduced insulin secretion → reduced inhibition of protein catabolism and lipolysis.Increased glucagon → stimulates lipolysis, gluconeogenesis, and glycogenolysis → increases blood glucose.
Anaphylaxis
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Vasopressors may be needed for refractory anaphylaxis, in which epinephrine and fluid hydration fail to correct hypotension and vasodilation (Brown 2005). For patients who are on β-blockers, anaphylaxis may be more severe, as hypotension and bronchospasm may be refractory to epinephrine. In these cases, IV glucagon can be administered. The airway should be protected, as rapid administration of glucagon can induce vomiting.
A primer on modelling pancreatic islets: from models of coupled β-cells to multicellular islet models
Published in Islets, 2023
Gerardo J. Félix-Martínez, J. Rafael Godínez-Fernández
Pancreatic islets, also known as islets of Langerhans, are mainly composed of ɑ, β and δ-cells, endocrine cells that secrete glucagon, insulin and somatostatin, respectively, critical hormones for the regulation of blood glucose. Insulin, the only hormone capable of reducing glucose levels directly, is secreted when blood glucose rises, producing its hypoglycemic effect by promoting the uptake of glucose by hepatic, muscular and adipose tissues. On the contrary, glucagon is secreted when blood glucose decreases, promoting the release of the stored glucose (i.e., glycogen) mainly from the liver to restore the normal glucose levels. Finally, somatostatin, secreted by δ-cells, is not involved in the regulation of blood glucose directly, although it has a relevant indirect role by inhibiting the secretion of both glucagon and insulin from ɑ and β-cells, respectively.1
Is retatrutide (LY3437943), a GLP-1, GIP, and glucagon receptor agonist a step forward in the treatment of diabetes and obesity?
Published in Expert Opinion on Investigational Drugs, 2023
Glucagon has many actions (discussed in Introduction) and some of these are likely to be useful in the treatment of diabetes and obesity, but for some of them it may not be obvious how they will be beneficial, e.g. increased glucose production from liver. Thus, I am having difficulty understanding the rationale for using glucagon receptor agonists in the treatment of diabetes and obesity. Also, new mechanisms are still being discovered for glucagon such as the ability to stimulate GLP-1 receptors on cultured islets [7], and the contribution to the actions of glucagon or its receptor agonists that this makes are still to be clarified. Pre-clinical comparison of the mechanisms and actions of retatrutide, which additional stimulates glucagon receptors, and tirzepatide that only stimulates GLP-1 and GIP receptors may be useful in elucidating the effects of glucagon receptor agonists.
Prehospital Intranasal Glucagon for Hypoglycemia
Published in Prehospital Emergency Care, 2023
Ameera Haamid, Errick Christian, Katie Tataris, Eddie Markul, Hashim Q. Zaidi, Mark B. Mycyk, Joseph M. Weber
Nasal administration of recombinant glucagon has been studied since the early 1980s in an effort to create an easy-to-use home treatment for hypoglycemia that family members of patients with diabetes could administer without necessitating an intramuscular injection. While a series of studies from 1983 to 1994 demonstrated that recombinant glucagon administered IN can successfully increase blood glucose levels, all included the use of additional absorption enhancers (glycocholic acid or didecanoyl-L-alpha-phosphatidycholine) to facilitate nasal absorption without which the nasal bioavailability of glucagon peptides is low (9–15). Additionally, these studies were all performed by nasal installation of drops and prior to the advent of the mucosal atomization device which may increase glucagon bioavailability. In 2013, Sibley et al. published a single case report of the successful treatment of prehospital hypoglycemia with the nasal administration of 1 mg of recombinant glucagon without the use of an absorption enhancer (16). Our prehospital study includes an additional 44 patients who received intranasal recombinant glucagon 1 mg using the mucosal atomization device and no absorption enhancer. 62% of our patients had some improvement in their mental status and blood glucose values and 32% had substantial improvement in both mental status and blood glucose, while 38% had no improvement in either.