Test ID: GLP
Glucagon, Plasma
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Diagnosis and follow-up of glucagonomas and other glucagon-producing tumors
Assessing diabetic patients with problematic hyper- or hypoglycemic episodes (extremely limited utility)
Glucagon is routinely measured along with serum glucose, insulin, and C-peptide levels, during the mixed-meal test employed in the diagnostic workup of suspected postprandial hypoglycemia. However, it plays only a minor role in the interpretation of this test.
Method Name A short description of the method used to perform the test
Immunoassay Following Extraction
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions:
1. Fasting.
2. Prechill tube at 4 degrees C before drawing the specimen.
3. Draw the prechilled tube, and process as follows:
a. After drawing specimen, chill tube in wet ice for 10 minutes.
b. Centrifuge in a refrigerated centrifuge or in chilled centrifuge cup.
c. Immediately after centrifugation, remove plasma, place in a plastic transport vial (Supply T465), and freeze.
Forms: If not ordering electronically, submit a General Request Form (Supply T239) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross OK |
| Icterus | Mild OK; Gross OK |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Plasma EDTA | Frozen | 90 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Glucagon is a single-chain polypeptide of 29 amino acids that is derived from a larger precursor peptide (big plasma glucagon), which is cleaved upon secretion. The main sites of glucagon production are the hypothalamus and pancreatic alpha-islet cells. The function of hypothalamic glucagon is incompletely understood and currently no clinical disorders of hypothalamic glucagon function have been defined. Pancreatic islet glucagon is secreted in response to hypoglycemia, with resultant increases in blood glucose concentration. Glucagon's hyperglycemic effect is produced by stimulating hepatic glycogenolysis and gluconeogenesis; it has no effect on muscle glycogen. Once blood-glucose levels have normalized, glucagon secretion ceases.
Excessive glucagon secretion can lead to hyperglycemia or aggravate preexisting hyperglycemia. Excessive and inappropriate glucagon secretion can sometimes be observed in diabetes, in particular during ketoacidosis, and can complicate management of the disorder. In rare cases, it also can occur in tumors of the pancreatic islets (glucagonoma); carcinoid tumors and other neuroendocrine neoplasms and hepatocellular carcinomas. Patients with glucagon-secreting tumors may present with classic glucagonoma syndrome, consisting of necrolytic migratory erythema, diabetes, and diarrhea, but also can have more subtle symptoms and signs.
Decreased or absent glucagon response to hypoglycemia can be seen in type I diabetes (insulin-dependent diabetes) and can contribute to severe and prolonged hypoglycemic responses.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
< or =6 hours: 100-650 pg/mL
1-2 days: 70-450 pg/mL
2-4 days: 100-650 pg/mL
4-14 days: declining gradually to adult levels
>14 days: < or =80 pg/mL (range based on 95% confidence limits)
Glucagon levels are inversely related to blood glucose levels at all ages. This is particularly pronounced at birth and shortly thereafter, until regular feeding patterns are established. This explains the higher levels immediately after birth, which then first fall as the glucagon release mobilizes the infant's glucose stores, then rise again as stores are depleted, finally normalizing towards adult levels as regular feeding patterns are established.
Interpretation Provides information to assist in interpretation of the test results
Elevated glucagon levels in the absence of hypoglycemia may indicate the presence of a glucagon-secreting tumor. Successful treatment of a glucagon-secreting tumor is associated with normalization of glucagon levels.
Inappropriate elevations in glucagon levels in hyperglycemic type I diabetic patients indicate that paradoxical glucagon release may contribute to disease severity. This can be observed if insulin treatment is inadequate and patients are ketotic. However, glucagon measurement plays little, if any, role in the diagnostic workup of diabetic ketoacidosis, which is based on demonstrating significantly elevated plasma or serum glucose (>250 mg/dL), circulating ketones (beta-hydroxy butyrate), and acidosis (typically with increased anion gap).
In diabetic patients, low glucagon levels (undetectable or in the lower quartile of the normal range) in the presence of hypoglycemia indicate impairment of hypoglycemic counter-regulation. These patients may be particularly prone to recurrent hypoglycemia. This can be a permanent problem due to islet alpha-cell destruction or other, less well understood processes (eg, autonomous neuropathy). It can also be functional, most often due to over tight blood-glucose control, and may be reversible after decreasing insulin doses.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Results obtained with different glucagon assays can differ substantially. This can be caused by use of different calibration standards. Different glucagon assays may also exhibit variable cross-reactivity with different isoforms of glucagon, not all of which are biologically active. Some assays, including this one, remove biologically inactive isoforms before measurement, while others do not. All these factors contribute to the differences between different assays. Serial measurements should, therefore, always be performed using the same assay.
Precise reference ranges for appropriate glucagon responses for given blood glucose ranges are not well established and vary widely from assay to assay. Expert advice should be sought when interpreting inappropriately low glucagon levels or when interpreting glucagon, insulin, and C-peptide levels obtained during mixed-meal testing.
Tumor marker tests, including glucagon, are not specific for malignancy. All immunometric assays can, on rare occasions, be subject to hooking at extremely high analyte concentrations (false-low results), heterophilic antibody interference (false-high results), or autoantibody interference (unpredictable effects). If the laboratory result does not fit the clinical picture, these possibilities should be considered.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Sherwood NM, Krueckl SL, McRory JE: The origin and function of the pituitary adenylate cyclase-activating polypeptide (PACAP)/glucagon superfamily. Endocrin Rev 2000 Dec;21(6):619-670
2. Tomassetti P, Migliori M, Lalli S, et al: Epidemiology, clinical features and diagnosis of gastroenteropancreatic endocrine tumours. Ann Oncol 2001;12 Suppl 2:S95-99
3. Cryer PE: Hypoglycemia risk reduction in type 1 diabetes. Exp Clin Endocrinol Diabetes 2001;109 Suppl 2:S412-423
4. Jhiang G, Zhang BB: Glucagon and regulation of glucose metabolism. Am J Physiol Metab 2003;284:E671-E678
5. vanBeek AP, de Haas ER, van Vloten WA, et al: The glucagonoma syndrome and necrolytic migratory erythema: a clinical review. Eu J Endocrinol 2004;151:531-537
Method Description Describes how the test is performed and provides a method-specific reference
Big plasma glucagon (BPG), which is considered to be biologically inactive, is extracted using ethanol prior to assay of the specimen. This enables accurate measurement of the biologically active glucagon in the specimen.(Hendriks T: Radioimmunoassay of clinically meaningful components of circulating glucagon: removal of big plasma glucagon prior to assay. Clin Chim Acta 1984;140:301-307) Following ethanol extraction, glucagon reacts with an antiglucagon antibody that is attached to tiny polystyrene beads. After incubation and washing, a second detection antibody is added and attaches to any bead-bound glucagon, forming a sandwich assay. A streptavidin-phycoerythrin (SPE) tag binds to the glucagon-antibody complex. Laser-based fluorescent analysis of the resulting glucagon-antibody-SPE complex is performed on the Luminex 200 instrument.(Package insert: Human Endocrine LINCOplex Kit, HENDO-65K-Rev. 03/03/06)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday, Thursday; 10 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82943
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 9358 | Glucagon, P | 2338-2 |
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