Diagnosis and testing for growth hormone deficiency across the ages: a global view of the accuracy, caveats, and cut-offs for diagnosis

Yuen, Kevin C.J.; Johannsson, Gudmundur; Miller, Bradley S.; Bergadá, Ignacio; Rogol, Alan D.

doi:10.1530/ec-22-0504

Cited by 22 publications

(7 citation statements)

References 175 publications

(346 reference statements)

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“…GSTs are useful tools in diagnosing GHD, especially in those without obvious causes of GHD such as intracranial tumors or irradiation ( 9 ). We acknowledge that several studies of various GH stimulation test protocols in different parts of the world have suggested different GH peak cut offs ranging from 5 to 10 ng/dL ( 31 ). But for all practical purposes the current agreed GH cut off in the United States remains to be 10 ng/dL ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Evolving growth hormone deficiency: proof of concept

Chimatapu,

Sethuram,

Samuels

et al. 2024

Front. Endocrinol.

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IntroductionWe present the evolution of GHD in adolescent males with persistent growth failure, in whom the diagnosis was established after a second GH stimulation test (GST).MethodsWe performed a retrospective chart review of children who presented for short stature (height less < 2SD for mean/mid-parental height) and/or growth failure (sustained growth velocity < 0 SD) to pediatric endocrinology at Mount Sinai Kravis Children’s Hospital, New York and who had 2 GSTs. Data collected from electronic medical records were analyzed using SPSS v28.0ResultsOf 53 patients included, 42 were males. Average GH peak on initial GST was 15.48 ± 4.92 ng/ml, at 10.07 ± 2.65 years, mean height -1.68 ± 0.56SD(28% had <2SD), IGF-1 -1.00 ± 0.88SD. After 2.23 ± 1.22 years, at 12.04 ± 2.41years, height SDs decreased to -1.82 ± 0.63SD and IGF-1 was -1.08 ± 0.84SD. At repeat GST, average GH peak was 7.59 ± 2.12 ng/dL, with 36% ≤7 ng/dl and 32% in puberty. 12 males reached adult height of 0.08 ± 0.69 SD with a mean height gain of 1.83 ± 0.56SD(p<0.005), IGF-1 of -1.15 ± 0.81SD after 4.64 ± 1.4 years of GH.ConclusionWe offer evidence for Evolving Growth Hormone Deficiency (EGHD) through repeat GST in children with persistent growth slowdown, even with pubertal progression; emphasizing the need for careful longitudinal follow-up to make accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%

Evolving growth hormone deficiency: proof of concept

Chimatapu,

Sethuram,

Samuels

et al. 2024

Front. Endocrinol.

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“…Whether lower cutoffs should be used with the newer, more sensitive, 2-site assays has not been definitively determined. According to newer studies, which used a sensitive, immunochemiluminescent, 2-site assay, the values of 5.1 μg/L for the ITT and 4.1 μg/L for the GH-releasing hormone–arginine test had sufficient specificity and sensitivity for the diagnosis of GHD [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis

Ach,

Ben Haj Slama,

Gorchane

et al. 2024

Journal of the Endocrine Society

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Background In some patients, symptoms may persist after COVID-19, defined as Long COVID. Its pathogenesis is still debated and many hypotheses have raised. Our primary objective was to evaluate the corticotroph and somatotroph functions of patients previously infected with SARS-CoV-2 and experiencing Post COVID-19 syndrome to detect any deficiencies that may explain Long COVID. Design A cross-sectional study was conducted including patients who had previously contracted SARS-CoV-2 with a post-infection period of 3 months or less to 15 months, divided into two groups. The first group (G1) comprised of fully recovered patients, while the second group (G2) included patients experiencing Long COVID. The primary outcome was the comparison of corticotroph and somatotroph functions. Results 64 patients were divided into two groups, each consisting of 32 patients. G2 exhibited more frequently anterior pituitary deficits compared to G1(p = 0.045). For the corticotroph axis (G1: 6.3% vs G2: 28.1%) and for the somatotroph axis (G1: 31.3% vs G2: 59.4%). Baseline cortisol level was significantly lower in G2 (G1: 13.37 µg/dL vs G2: 11.59 µg/dL) (p = 0.045). The peak cortisol level was also lower in G2 (G1: 23.60 µg/dL vs G2: 19.14 µg/dL) (p = 0.01). For the somatotroph axis, the IGF-1 level was lower in G2 (G1: 146.03 ng/mL vs G2: 132.25 ng/mL) (p = 0.369). The peak GH level was also lower in G2 (G1: 4.82 ng/mL vs G2: 2.89 ng/mL) (p = 0.041). Conclusions The results showed that Long COVID patients in our cohort were more likely to have anterior pituitary deficiencies. The endocrine hypothesis involving anterior pituitary insufficiency can be considered to explain the Long COVID.

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“…None of the patients reported common stimulation test related side effects, such as facial flushing, nausea, headache or transient dysgeusia [20].…”

Section: Ghrh/arginine Testmentioning

confidence: 95%

The somatotroph pituitary gland function in high-aged multimorbid hospitalized patients with IGF-I deficiency

Tausendfreund,

Bidlingmaier,

Martini

et al. 2024

Pituitary

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Purpose It is unclear whether the age-related decline in the somatotropic axis stems from a reduced growth hormone (GH) production in the pituitary gland, or from a peripheral origin akin to an acquired GH resistance. With the help of a GHRH/arginine test, high-aged multimorbid hospitalized patients with IGF-I deficiency are to be tested to determine whether there is primarily a pituitary GH deficiency in the sense of a somatopause. Methods Seventeen multimorbid patients (eleven men and six women) with a mean age of 82 years, with IGF-I concentrations below two standard deviations of 30-year-old men and women were identified. Patients suffered from a variety of common age-related stable diseases including coronary artery disease, chronic liver or kidney disease, chronic heart failure as well as acute conditions e.g., urosepsis or endocarditis. To assess the somatotropic axis they underwent a GHRH/arginine test. Results were evaluated using descriptive statistics. Results In average, the peak concentration of GH after stimulation was 14.8 µg/L with a range from 2.76 to 47.4 µg/L. Taking into account both, gender and BMI (with a mean of 26.5 kg/m²) for each participant, the pituitary gland was adequately stimulated in 16 out of the 17 patients. No patient reported common side effects related to the GHRH/arginine test. Conclusion The somatotroph pituitary gland retains its secretory capacity in the advanced aged. Therefore, age does not seem to be the driving pacemaker for the functional decline of the somatotropic axis within the aged population.

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Diagnosis and testing for growth hormone deficiency across the ages: a global view of the accuracy, caveats, and cut-offs for diagnosis

Cited by 22 publications

References 175 publications

Evolving growth hormone deficiency: proof of concept

Evolving growth hormone deficiency: proof of concept

Explaining Long COVID: A Pioneer Cross-Sectional Study Supporting the Endocrine Hypothesis

The somatotroph pituitary gland function in high-aged multimorbid hospitalized patients with IGF-I deficiency

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