A single growth hormone (GH) determination is sufficient for the diagnosis of GH‐deficiency in adult patients using the growth hormone releasing hormone plus growth hormone releasing peptide‐6 test

Leal, Alfonso; Lage, Mary; Popović, Vera; Torres, E.; Koppeschaar, H. P. F.; Páramo, C.; Micić, Dragan; García‐Mayor, Ricardo V.; Diéguez, Carlos; Casanueva, F. F.

doi:10.1046/j.1365-2265.2002.01623.x

Cited by 19 publications

(9 citation statements)

References 55 publications

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“…In the majority of control subjects, the peak occurred at 30 min and for most GH-deficient patients, it was earlier, at 15 min, but the GH values at 30 min were almost of the same magnitude as the peak values. Therefore, a single 30 min sample would provide similar diagnostic information on peak GH as that reported for the GHRH plus GHRP test (14,15,32).…”

Section: Discussionmentioning

confidence: 86%

A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency

Chihara

Shimatsu²,

Hizuka³

et al. 2007

eur j endocrinol

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Objective: The international, first-line diagnostic test for adult GH deficiency is the insulin tolerance test (ITT), which is contraindicated in some patients due to severe adverse events. Alternatives such as GH-releasing hormone combined with arginine or GH-releasing peptides (GHRP) have been proposed. We validated the use of GHRP-2 for diagnosing adult GH deficiency (GHD). Methods: Seventy-seven healthy subjects and 58 patients with peak GH!3 mg/l by ITT were enrolled. After overnight fasting, a 100 mg dose of GHRP-2 was administered intravenously; blood samples were taken during the subsequent 2 h and GH measured by immunoradiometric assay. Results: Serum GH peak occurred within 60 min after GHRP-2 administration in all subjects. GH responses to GHRP-2 were not affected by gender, but were slightly lower in elderly subjects and those with adiposity, although these did not influence diagnosis of GHD. Repeated tests showed favourable reproducibility. Peak GH concentrations after GHRP-2 were significantly (P!0.001) lower in patients (1.36G2.60 mg/l) than the healthy group (84.6G60.9 mg/l) with no difference between hypothalamic and pituitary diseases. Serum GH concentration at the point where sensitivity of response crossed with specificity ranged from 15 to 20 mg/l. A cut-off value of 15 mg/l for diagnosing GHD with GHRP-2 corresponded to the diagnostic value of 3 mg/l in the ITT. Conclusions: The GHRP-2 provocative test showed favourable reproducibility and was mildly influenced by age and adiposity. Severe GH deficiency could be diagnosed with high reliability using a 15 mg/l (9 mg/l when GH calibrated with recombinant World Health Organization 98/574 standard) cut-off for peak GH concentration.

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Section: Discussionmentioning

confidence: 86%

A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency

Chihara

Shimatsu²,

Hizuka³

et al. 2007

eur j endocrinol

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“…As for the GHRH + ARG, the GHRH + GHRP-6 test shows a very good safety profile and lack of contraindications [39,44]. In addition, the latter test provides a similar advantage in that it can be performed in a shortened procedure in which GH levels are measured at one single time point only and in a single session [70].…”

Section: Reliable Provocative Tests and Appropriate Cut-off Limitsmentioning

confidence: 98%

Growth hormone levels in the diagnosis of growth hormone deficiency in adulthood

Corneli¹,

Gasco

Prodam³

et al. 2007

Pituitary

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Current guidelines for the diagnosis of adult growth hormone deficiency (GHD) state that the diagnosis must be proven biochemically by provocative testing that is done within the appropriate clinical context. The need for reliance on provocative testing is based on evidence that the evaluation of spontaneous growth hormone (GH) secretion over 24 h and the measurement of IGF-I and IGFBP-3 levels do not distinguish between normal and GHD subjects. Regarding IGF-I, it has been demonstrated that very low levels in patients highly suspected for GHD (i.e., patients with childhood-onset, severe GHD, or with multiple hypopituitarism acquired in adulthood) may be considered definitive evidence for severe GHD obviating the need for provocative tests. However, normal IGF-I levels do not rule out severe GHD and therefore adults suspected for GHD and with normal IGF-I levels must undergo a provocative test of GH secretion. The insulin tolerance test (ITT) is the test of choice, with severe GHD being defined by a GH peak less than 3 microg/l, the cut-off that distinguishes normal from GHD adults. The ITT is contraindicated in the presence of ischemic heart disease, seizure disorders, and in the elderly. Other tests are as reliable as the ITT, provided they are used with appropriate cut-off limits. Glucagon stimulation, a classical test, and especially new maximal tests such as GHRH in combination with arginine or GHS (i.e., GHRP-6) have well-defined cut-off limits, are reproducible, are independent of age and gender, and are able to distinguish between normal and GHD subjects. The confounding effect of overweight or obesity on the interpretation of the GH response to provocative tests needs to be considered as the somatotropic response to all stimuli is negatively correlated with body mass index. Appropriate cut-offs for lean, overweight, and obese subjects must be used in order to avoid false-positive diagnoses of severe GHD in obese adults.

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“…Moreover, this test too would be performed in a shortened procedure evaluating GH levels at one single time point and in a single session [70].…”

Section: Provocative Tests Alternative To Ittmentioning

confidence: 99%

Diagnosis of adult GH deficiency

Ghigo

Aimaretti

Corneli

2008

Growth Hormone & IGF Research

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A single growth hormone (GH) determination is sufficient for the diagnosis of GH‐deficiency in adult patients using the growth hormone releasing hormone plus growth hormone releasing peptide‐6 test

Abstract: The GHRH + GHRP-6 test is a convenient, safe and reliable, provocative test of GH reserve in adults, which can be reduced to a single fixed GH determination 30 minutes after stimulus.

Cited by 19 publications

References 55 publications

A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency

A simple diagnostic test using GH-releasing peptide-2 in adult GH deficiency

Growth hormone levels in the diagnosis of growth hormone deficiency in adulthood

Diagnosis of adult GH deficiency

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