The insulin tolerance test is discouraged in children.
2.
Some suggest that an ACTH stimulation test is sufficient as first-line investigation, and that an insulin tolerance test is only needed if the ACTH test is equivocal.
3.
An insulin tolerance test has been shown to be reproducible, age-independent, and able to distinguish between GHD and normal adults, and so is the test of choice.
4.
However, in order to check the functionality of the Hypothalamic Pituitary Adrenal ( HPA ) Axis the entire axis must be tested by way of ACTH stimulation test, CRH stimulation test and perhaps an Insulin Tolerance Test ( ITT ).
5.
If secondary adrenal insufficiency is diagnosed, the insulin tolerance test ( ITT ) or the CRH ( corticotropin-releasing hormone ) stimulation test can be used to distinguish between a hypothalamic ( tertiary ) and pituitary ( secondary ) cause, but is rarely used in clinical practice.
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