MICROANATOMY

Detailed explanation-1: -The insulin stress test (IST) (or insulin tolerance test, ITT) has traditionally been the ‘gold standard’ test to assess the adequacy of the ACTH–adrenal axis. After adequate hypoglycaemia (blood glucose <2.2 mmol/L), a normal rise of plasma cortisol (traditionally to >550 nmol/L) excludes ACTH and cortisol deficiency.

Detailed explanation-2: -Insulin Tolerance Test The ITT has traditionally been accepted as the gold standard test for the assessment of adult GHD, with a GH cut-point of 3-5 g/L when adequate hypoglycemia (blood glucose < 40 mg/dL) is achieved (8, 16, 17).

Detailed explanation-3: -The glucagon stimulation test has become the most commonly used diagnostic test for the diagnosis of GH deficiency because of its availability, reproducibility, safety, and lack of influence by sex and hypothalamic cause of GH deficiency.

Detailed explanation-4: -Macimorelin is indicated for diagnosis of adult growth hormone deficiency.