Diagnostic controversy: the diagnosis of childhood growth hormone deficiency revisited.

Rosenfeld, Ron G.; Albertsson‐Wikland, Kerstin; Cassorla, Fernando; Frasier, S. Douglas; Hasegawa, Yukihiro; Hintz, Raymond L.; LaFranchi, Stephen; Lippe, Barbara M.; Loriaux, Lynn; Melmed, Shlomo

doi:10.1210/jcem.80.5.7538145

Cited by 191 publications

(125 citation statements)

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“…However, insufficient numbers of patients, different therapy durations, and changes in the time of the dosage prescribed, due, in particular, to a greater availability of the hormone, have led to different results (10,11). In addition, the modifications recently made in the therapy schedule and administration route, as well as the uncertainties of the diagnostic criteria indicating the subjects to be treated (13)(14)(15)(16)(17)(18)(19)(20)(21), will probably further change the final results of the treatment. It is certain, however, that the experience acquired to date has not enabled us to adopt an optimal therapeutic approach, either for the single patient or for the whole group, casting doubt on the auxological outcome of the patients treated.…”

Section: Introductionmentioning

confidence: 99%

Final height of patients treated for isolated GH deficiency: examination of 83 patients

Cacciari

Cicognani

Pirazzoli

et al. 1997

European Journal of Endocrinology

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The aim of the present study was to evaluate retrospectively the influence of various auxological and laboratory parameters on final height in a group of GH-deficient children after replacement therapy and to compare their final height with that of a group of short children with normal GH secretion and hence not treated.The final height was evaluated of 83 patients (51 males and 32 females) affected by idiopathic isolated GH deficiency and treated with recombinant human GH (hGH) for 2-7 years. Inclusion criteria at the start of treatment were short stature (mean height for chronological age in standard deviation score (SDS) ¹2.21) due to idiopathic isolated GH deficiency (GH peak <8 mg/l after two pharmacological tests and/or mean GH concentration <3.3 mg/l during the night) and treatment with recombinant hGH for at least 2 years at a dose of 15-20 U/m 2 per week by s.c. injection for 6 or 7 days/ week. Mean chronological age at diagnosis was 12.2 Ϯ 1.7 years; 35 were prepubertal and 48 pubertal. The final height of 51 untreated short stature (mean height for chronological age in SDS ¹2.13 at diagnosis) subjects (42 males and 9 females; 29 prepubertal and 22 pubertal at diagnosis with mean chronological age 11.6 Ϯ 2.4 years) with normal GH secretion was also evaluated.In the treated subjects final height SDS was higher than that of the untreated group (¹1.3 vs ¹1.7 SDS; P ¼ 0.01). Both treated and untreated subjects showed a final height lower than target height, but 39% of the treated subjects vs only 20% of the untreated group (P ¼ 0.035) had a final height greater than target height. In the treated subjects this percentage was higher in the patients improving their height for bone age in the first years of therapy. While treated females showed a positive correlation only between target and final height (P ¼ 0.0001), in treated males final height correlated with the Bayley-Pinneau prediction at diagnosis, height for chronological age and bone age at diagnosis and target height. Patients who started therapy before puberty also showed these correlations with data calculated at the onset of puberty, together with a correlation with chronological age at the onset of puberty.When considering the influence of GH response at tests on final height, the percentage of subjects exceeding target height increased progressively according to the severity of the GH deficiency. There was no difference in height gain between the patients starting therapy before or during puberty. The height gain, however modest, obtained by our treated patients, the number of patients with final height greater than target height and the favourable comparison with the untreated short-stature subjects represent a promising result, which could be improved by personalizing treatment. European Journal of Endocrinology 137 53-60

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Section: Introductionmentioning

confidence: 99%

Final height of patients treated for isolated GH deficiency: examination of 83 patients

Cacciari

Cicognani

Pirazzoli

et al. 1997

European Journal of Endocrinology

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“…If we search for an alternative test to the diagnosis of GHD, it is not only necessary to define the most powerful one; the test must discriminate between normal and GHD individuals. It is known that GH secretion may be affected by poor reproducibility of response to both physiological and pharmacological tests (26)(27)(28)(29)(30). This may be very important in respect of qualifying patients to GH therapy.…”

Section: Discussionmentioning

confidence: 99%

Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men

Micmacher

Assumpção

Redorat

et al. 2009

Arq Bras Endocrinol Metab

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Objective: To investigate the growth hormone (GH) response to glucagon stimulation test (GST) in a population of healthy men over 50 years old in comparison to insulin tolerance test (ITT), analysis of the spontaneous 24-hour GH profile and insulin-like growth factor 1 (IGF-I). Me thods: 27 healthy men aged between 51 and 65 years were tested. Results: Using non-parametric correlation analysis, a positive correlation between GH peak after GST and mean IGF-I (r = 0.528; p = 0.005) was found, as well with GH peak in 24-hour profile (r = 0.494; p = 0.009). No correlation was found comparing GH peak after ITT with the same parameters. Ten subjects presented GH peak of less than 3.0 μg/L after GST, none confirmed in ITT. Conclusions: GH peak response to GST was lower than ITT, but it showed a positive correlation with mean IGF-I and also with GH peak in 24-hour profile. However, GST should not be used to differentiate organic growth hormone deficiency (GDH) from the expected decline on GH secretion due to aging. Arq Bras Endocrinol Metab. 2009;53(7):853-8. KeywordsGrowth hormone; somatopause; glucagon RESUMO Objetivo: Investigar a resposta do hormônio do crescimento (GH) ao teste de estímulo com glucagon (GST) numa população de homens saudáveis acima dos 50 anos de idade, em comparação ao teste de tolerância à insulina (ITT), além da análise do perfil de secreção espontânea de GH nas 24 horas e fator de crescimento semelhante à insulina (IGF-I) basal. Métodos: 27 homens, com idades entre 51 e 65 anos, foram submetidos aos testes. Resultados: Utilizando análise de correlação não paramétrica, encontrou-se correlação positiva entre o pico de GH pós-GST e a média de IGF-I (r = 0,528; p = 0,005), e também com o pico espontâneo do GH no perfil de 24 horas (r = 0,494; p = 0,009). Não houve correlação do pico de GH pós-ITT com os mesmos parâmetros. Dez indivíduos apresentaram pico de GH após GST inferior a 3,0 μg/L, sem confirmação no ITT. Conclusões: O pico de GH pós-GST foi menor do que o obtido pós-ITT, porém demonstrou correlação positiva com a média de IGF-I e o pico de GH na secreção espontânea de 24 horas. Entretanto, o GST não demonstrou ser um bom teste para distinguir entre deficiência de hormônio de crescimento (DGH) e somatopausa. Arq Bras Endocrinol Metab. 2009;53(7):853-8. DescritoresHormônio do crescimento; somatopausa; glucagon

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“…Neste artigo propomos o diagnóstico da deficiência de GH (DGH) baseado em uma hierarquia de dados semiológicos e laboratoriais: avaliação clínica e auxológica, dosagens de componentes do eixo GHIGFs e testes de estímulo da secreção de GH (13)(14)(15).…”

Section: Introductionunclassified

Diagnóstico da Deficiência de Hormônio de Crescimento, a Rigor de IGF-1

Júnior

Oliveira

Brito

et al. 2002

Arq Bras Endocrinol Metab

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RESUMOO diagnóstico da deficiência de IGF-1 por anormalidade do eixo GH-IGF deve utilizar os parâmetros diagnósticos mais adequados para cada faixa etária e estágio puberal. Propomos o diagnóstico da deficiência de GH (DGH) baseado em uma hierarquia de dados clínicos e laboratoriais. A avaliação clínica e os exames laboratoriais gerais, incluindo função tireoideana, permitem excluir etiologias de deficiência de IGF que não as intrínsecas ao eixo GH-IGF. Nestas, a dosagem do IGF-1 séri-co deve ser o primeiro hormônio a ser dosado nos grupos pré-púberes, púberes e idosos. No grupo de adultos jovens, a dosagem do ALS livre é a mais adequada. As concentrações de IGF-1 podem caracterizar 4 situações: muito reduzido, reduzido, normal e elevado. IGF-1 menor que 35µg/L ou -2 DP da média para a idade cronológica (EDP-IC) permite o diagnóstico de deficiência de IGF-1. Nesta situação, a realização de apenas um teste de secreção de GH é necessária para diferenciar deficiência e resistência ao GH. O teste de geração de IGF-1 ajuda a confirmar o diagnóstico de resistência ao GH. IGF-1 menor que 70µg/L em pré-púberes ou adultos e menor que 170µg/L em indivíduos púberes, ou entre -2 e -1 EDP-IC indicam provável deficiência de IGF-1. A realização de 2 testes de secreção de GH é recomendada; resposta sub-normal em ambos indica DGH. Exame de imagem da região hipotálamo-hipofisária deve ser realizado nos casos de DGH. Resposta normal ao teste de secreção do GH frente à forte suspeita clínica e laboratorial de deficiência de IGF-1 indica a realização de perfil noturno de GH para afastar o diagnóstico de disfunção neurossecretora de GH. IGF-1 maior que -1 DP, mas menor que a média para idade cronológica sugere ausência de deficiência de IGF-1. Concentrações altas de IGF-1 impõem a dosagem das IGFBPs e consideração da resistência ao IGF-1. Apesar das dificuldades, todo o esforço deve ser feito no sentido de diagnosticar adequadamente as alterações do eixo GH-IGF para instituir a terapia apropriada. The diagnosis of IGF-1 deficiency due to GH-IGF abnormalities must use the most appropriate parameters for age and pubertal stage. We propose the diagnosis of growth hormone deficiency (GHD) based in an hierarchy of clinical and laboratory data. Clinical evaluation and general laboratory tests, e.g. thyroid tests, permit to exclude other causes of IGF deficiency that are not intrinsic to the GH-IGF axis. In these, the measurement of serum IGF-1 must be the first step in prepubertal, pubertal and elderly groups of patients whereas free ALS is better among young adults. IGF-1 analysis can revel 4 different situations: very low, low, normal and high levels. IGF-1 lower than 35µg/L or -2 SD of mean for chronological age (SDS-CA) allows diagnosis of IGF-1 deficiency. In this situation, only 1 test for GH secretion is necessary to differentiate GH deficiency atualização

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Diagnostic controversy: the diagnosis of childhood growth hormone deficiency revisited.

Cited by 191 publications

References 98 publications

Final height of patients treated for isolated GH deficiency: examination of 83 patients

Final height of patients treated for isolated GH deficiency: examination of 83 patients

Growth hormone secretion in response to glucagon stimulation test in healthy middle-aged men

Diagnóstico da Deficiência de Hormônio de Crescimento, a Rigor de IGF-1

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