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Glucagon-stimulated copeptin response in children: a proof-of-concept study

Rita Indirli1,2, Federico Giacchetti1, Eriselda Profka1,2

  • 1Endocrinology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.

Frontiers in Endocrinology
|June 29, 2026
PubMed

Insights

The glucagon stimulation test (GST) effectively increases copeptin levels in children, showing promise for diagnosing polyuria-polydipsia syndrome (PPS). Further research is needed to confirm its diagnostic accuracy in pediatric cases.

Area of Science:

  • Pediatric Endocrinology
  • Diagnostic Testing
  • Hormone Assays

Background:

  • The diagnostic workup for polyuria-polydipsia syndrome (PPS) in children is not well-established.
  • Non-osmotic copeptin-stimulating agents are being investigated for PPS diagnosis.
  • Glucagon stimulation test (GST) shows a robust copeptin response in adults, but data in children are lacking.

Purpose of the Study:

  • To investigate the copeptin response to the glucagon stimulation test (GST) in children.
  • To evaluate GST's potential in diagnosing growth hormone (GH) deficiency and PPS in pediatric patients.

Main Methods:

  • Twenty children (9 girls, mean age 10.3 years) without PPS underwent GST.
  • Plasma glucose, GH, cortisol, and copeptin levels were measured pre- and post-glucagon injection at multiple time points.

Main Results:

  • GST induced a significant increase in copeptin levels, with peak concentration at 150 minutes (+87%).
  • Median copeptin increased from 4.1 pmol/L at baseline to 10.6 pmol/L at peak.
  • No adverse events were reported during the GST procedure.

Conclusions:

  • GST is a safe and effective method for stimulating copeptin secretion in children with normal neurohypophysial function.
  • Further studies are warranted to establish GST's accuracy in the differential diagnosis of pediatric PPS.
Abstract

Keywords:
arginine-vasopressin deficiency (AVP-D)copeptinglucagon stimulation testgrowth hormone (GH) deficiencypolyuria-polydipsia syndrome

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