Assessing Short-Statured Children for Growth Hormone Deficiency

Abstract

Aim: To optimize the workup of short-statured children by defining the most appropriate tools for diagnosing growth hormone (GH) deficiency. Methods: Patients were assigned to prepubertal (n = 113) or pubertal (n = 112, including 25 boys primed with testosterone) age groups. Mean plasma GH concentration during sleep, GH peak after provocative test, and insulin-like growth factor I (IGF-I) were measured in a single evaluation. Results: The mean GH concentration during sleep was more often normal (n = 155) than the GH peak after provocative tests (n = 105) or the IGF-I concentration (n = 88). Prepubertal patients with a normal body mass index (BMI) had mean GH concentrations during sleep that correlated positively with height, growth rate, GH peak after provocative tests, and IGF-I (p < 0.0005 for all) and negatively with the difference between target and patient heights (p = 0.01) and BMI (p < 0.05). Pubertal patients with a normal BMI had a mean GH concentration during sleep that correlated positively with GH after provocative tests (p < 0.0001) and IGF-I (p < 0.005). Mean GH concentration during sleep and IGF-I concentration for boys primed with testosterone were more often normal (n = 23) than the GH peak after provocative tests (n = 14). All 9 patients with pituitary stalk interruption had low IGF-I concentrations; 1 patient had a normal GH peak after provocative test, and 2 patients had normal mean GH concentrations during sleep. Conclusions: Measuring the GH concentration during sleep and priming boys with pubertal delay can help to exclude idiopathic GH deficiency. Magnetic resonance imaging is needed to exclude anatomic abnormalities when GH and/or IGF-I concentrations are low.

Idiopathic short stature: Definition, epidemiology, and diagnostic evaluation

“…It is possible to identify children with a normal GH peak during stimulation testing but low endogenous secretion and also children with low GH during stimulation testing but normal endogenous secretion [50,51,167,168]. There is no consensus on when endogenous GH secretion should be evaluated and local practice will be followed.…”

Evaluation of Short Stature, Carbohydrate Metabolism and Other Endocrinopathies in Bloom’s Syndrome

“…Considered normal for nighttime GH production in children and adolescents was a mean GH concentration ≥3 ng/ml with 1 or more GH peaks >10 ng/ml [13]. Although normative data for nighttime GH secretion in adults are unavailable, one report defined abnormal as a mean concentration <0.6 ng/ml [14].…”

The evaluation of growth and the identification of growth hormone deficiency

“…23 24 Some centres measure spontaneous nocturnal pulsatile GH release to provide greater insight into secretory control mechanisms. 25 The relevance of this to short stature assessment or as a predictor of response to treatment remains controversial, although there may be a relationship between the amplitude of GH pulses and growth velocity. 26 However, GH profiles are time-intensive to perform and are impracticable for ''screening'' large numbers of children.…”