Clinical and laboratory parameters predicting a requirement for the reevaluation of growth hormone status during growth hormone treatment

Vurallı, Doğuş; Gönç, E. Nazlı; Özön, Z. Alev; Alikaşifoğlu, Ayfer; Kandemir, Nurgün

doi:10.1016/j.ghir.2017.05.003

Cited by 14 publications

(10 citation statements)

References 32 publications

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“…This finding requires further investigations on the significance of the results of GH stimulation tests for GH therapy effectiveness. It seems that the variability of GH response to stimulation should be taken into account, as previous studies have documented both early normalization of decreased GH secretion ( 30 , 31 , 32 ) and the converse situation ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Pre-treatment growth and IGF-I deficiency as main predictors of response to growth hormone therapy in neural models

Smyczyńska

Hilczer

et al. 2018

Endocrine Connections

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Mathematical models have been applied in prediction of growth hormone treatment effectiveness in children since the end of 1990s. Usually they were multiple linear regression models; however, there are also examples derived by empirical non-linear methods. Proposed solution consists in application of machine learning technique – artificial neural networks – to analyse this problem. This new methodology, contrary to previous ones, allows detection of both linear and non-linear dependencies without assuming their character a priori. The aims of this work included: development of models predicting separately growth during 1st year of treatment and final height as well as identification of important predictors and in-depth analysis of their influence on treatment’s effectiveness. The models were derived on the basis of clinical data of 272 patients treated for at least 1 year, 133 of whom have already attained final height. Starting from models containing 17 and 20 potential predictors, respectively for 1st year and final height model, we were able to reduce their number to 9 and 10. Basing on the final models, IGF-I concentration and earlier growth were indicated as belonging to most important predictors of response to GH therapy, while results of GH secretion tests were automatically excluded as insignificant. Moreover, majority of the dependencies were observed to be non-linear, thus using neural networks seems to be reasonable approach despite it being more complex than previously applied methods.

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Section: Discussionmentioning

confidence: 99%

Pre-treatment growth and IGF-I deficiency as main predictors of response to growth hormone therapy in neural models

Smyczyńska

Hilczer

et al. 2018

Endocrine Connections

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“…Taken together, these results indicate the poor diagnostic accuracy of unprimed GHST in the peripubertal phase, likely due to the physiological transient blunting of GH response to stimulation in this period of life. 27 IGF-1 values were not useful to differentiate between pre/peripubertal CDGP and GHD in the initial diagnostic process nor to differentiate true and permanent GHD after retesting from transient forms of IGHD. This could be possibly related to the poor sensitivity of IGF-1 and its fluctuations in relation to pubertal and nutritional status.…”

Section: Discussionmentioning

confidence: 80%

“…We believe that, although this comparison only approaches the significance threshold, it is of much interest and could become statistically significant by increasing the sample size. Taken together, these results indicate the poor diagnostic accuracy of unprimed GHST in the peripubertal phase, likely due to the physiological transient blunting of GH response to stimulation in this period of life 27 …”

Section: Discussionmentioning

confidence: 86%

Clinical benefits of sex steroids given as a priming prior to GH provocative test or as a growth‐promoting therapy in peripubertal growth delays: Results of a retrospective study among ENDO‐ERN centres

Galazzi

Improda²,

Cerbone

et al. 2020

Clinical Endocrinology

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“…In a more recent study Vuralli et al have retested all patients formerly diagnosed with GHD after only 1 year of treatment: the 40.6% of those with isolated GHD had a complete normalization of GH secretion, even if they had showed a severe deficiency with a very low GH-peak at diagnosis [46].…”

Section: Discussionmentioning

confidence: 99%

Growth Hormone (GH) Therapy During the Transition Period: Should We Think about Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?

Penta

Cofini

Lucchetti

et al. 2019

IJERPH

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To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone–releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<−2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than −2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.

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Clinical and laboratory parameters predicting a requirement for the reevaluation of growth hormone status during growth hormone treatment

Cited by 14 publications

References 32 publications

Pre-treatment growth and IGF-I deficiency as main predictors of response to growth hormone therapy in neural models

Pre-treatment growth and IGF-I deficiency as main predictors of response to growth hormone therapy in neural models

Clinical benefits of sex steroids given as a priming prior to GH provocative test or as a growth‐promoting therapy in peripubertal growth delays: Results of a retrospective study among ENDO‐ERN centres

Growth Hormone (GH) Therapy During the Transition Period: Should We Think about Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?

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