Is Sex Hormone Priming in Peripubertal Children prior to Growth Hormone Stimulation Tests Still Appropriate?

Lazar, Liora; Phillip, Moshe

doi:10.1159/000284396

Cited by 35 publications

(35 citation statements)

References 45 publications

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“…Recently, Lazar and Phillip [25] have reviewed the available published data and suggested that priming should be considered only in adolescents with pubertal delay, girls aged 11.5-12 years and boys aged 13-13.5 years, exhibiting no evidence of puberty or only initial signs. The children evaluated in our study showed a mean chronological age of 11.34 ± 2.99 years (boys) and 9.87 ± 2.14 years (girls).…”

Section: Discussionmentioning

confidence: 99%

“…A sex hormone priming before GH stimulation tests was not performed in our cohort of children due to the absence of a consensus about this point and controversial data from the literature [24,25,26,27]. However, to reinforce the diagnosis of GHD, as auxological data we considered height (standard deviation, SD), height velocity (HV) 1 year before the diagnosis (SD) and height in comparison to the midparental height (SD).…”

Section: Methodsmentioning

confidence: 99%

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Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

Ciresi

Guarnotta²,

Amato³

et al. 2014

Horm Res Paediatr

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Background/Aim: The significance of changes in thyroid function in children during growth hormone (GH) treatment remains uncertain. We aimed to evaluate the impact of GH replacement on thyroid status in children with idiopathic GH deficiency (GHD). Methods: Data of 105 GHD children (82 M, 23 F; aged 11.13 years) during a 36-month follow-up were analyzed. At diagnosis the areas under the curve of GH (AUC_GH) were calculated during a GH-releasing hormone + arginine (GHRH-Arg) and insulin tolerance test. Results: A significant ΔfT₃ (p < 0.001) was documented at 12 months, without any further change at 24 and 36 months and without fT₄ and TSH modifications. Grouping patients according to ΔfT₃ at 12 months into those with lower (n = 80, 76%) or greater values than the 75th percentile (n = 25, 24%), the latter showed lower AUC_GH and GH peak during a GHRH-Arg (p = 0.018 and 0.014, respectively) and insulin tolerance test (p = 0.023 and 0.020, respectively) at diagnosis. In addition, children with lower GH at diagnosis showed a greater ΔfT₃ at 12 months (p = 0.030). Conclusions: In GHD children, GH treatment is associated with a significant increase in fT₃ in the first 12 months, more pronounced in patients with more severe GHD, highlighting the strong correlation between severity of GHD and thyroid metabolism.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

Ciresi

Guarnotta²,

Amato³

et al. 2014

Horm Res Paediatr

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“…However, not all paediatric endocrinologists agree that sex-hormone priming is required [45], since it only briely augments the GH response which then returns to suboptimal concentrations and this may lead to underdiagnosis of peri-pubertal children that could have beneited from GH treatment. Some authors recommend that priming may be considered only in adolescents with pubertal delay (girls aged >11.5 12 years and boys aged >13 13.5 years) with no signs of puberty or only initial ones [46]. Therefore, at present there is no agreement on the use of priming.…”

Section: Provocative Gh Testingmentioning

confidence: 99%

Growth hormone deficiency: diagnosis and therapy in children

Bozzola¹,

Meazza

2010

Expert Review of Endocrinology & Metabolism

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Short stature has been deined as a height below the 2 standard deviation for age, sex and ethnicity. Growth hormone deiciency (GHD) represents a condition characterized by reduced GH secretion, isolated or associated with other pituitary hormone deiciencies. In a child with short stature and growth deceleration, after the exclusion of other causes of growth failure, the diagnosis of GHD has to be conirmed by measurement of GH secretion after at least two stimulation tests. Patients with GHD should be treated with rhGH as soon as possible, to obtain normalization of growth and normal inal height. The catch-up growth in response to rhGH therapy is maximal during the irst years and could be afected by many variables, such as birth-weight, age and height at start of treatment and of puberty, and duration of treatment. Overall, rhGH is believed to be safe and signiicant side-efects in children are very rare, including benign intracranial hypertension, hyperglycaemia, arthralgia and myalgia. Patients with childhood onset GHD are usually retested in late adolescence to conirm the GHD persistence and to continue of GH therapy. In conclusion, the present chapter provides useful and updated information about the diagnosis, treatment and follow-up of children with GHD.

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“…According to Lazar and Phillip from Israel, priming should not be routinely performed in every peripubertal child undergoing GH evaluation but considered only in adolescents with pubertal delay, i.e. girls >11.5-12 years and boys >13-13.5 years [4]. The guidelines of the Paediatric Endocrine Society suggested giving β-estradiol orally to both boys and girls on two evenings preceding the test.…”

Section: Introductionmentioning

confidence: 99%

Short-term adverse effects of testosterone used for priming in prepubertal boys before growth hormone stimulation test

Albrecht

Penger

Marx

et al. 2017

Journal of Pediatric Endocrinology and Metabolism

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Background: Despite the fact that priming with sex steroids in prepubertal children before growth hormone (GH) provocative tests is recommended, there is an ongoing controversial discussion about the appropriate age of the children, the drug used for priming, the dose and the period between priming and the GH test. Interestingly, there is no discussion on the safety of this procedure. To date, only little data have been available on the possible side effects of priming with testosterone. Methods: We analyzed the outcome in 188 short-statured prepubertal boys who had been primed with testosterone enanthate (n = 136: 50 mg; n = 51: 125 mg, and accidentally one boy with 250 mg) 7 days prior to the GH test. Serum testosterone levels were measured on the day of the GH test in 99 boys. Results: Overall, only five boys developed adverse side effects. Two boys (dose 125 mg) showed severe low-flow priapism and had to undergo decompression of the corpora cavernosa. One boy suffered from self-limiting priapism and testicular pain (dose 50 mg). Two patients reported testicular pain (each dose 50 mg). The single patient with 250 mg testosterone did not show any adverse effects. The total side effect rate was 2.7%. The serum testosterone levels of the boys with side effects were not different from the testosterone levels of the boys without any side effects. Conclusions: Parents and patients should be informed about the possible side effects of priming with testosterone such as priapism and testicular pain. However, the overall side effect rate is low. We found no correlation between the outcome and the testosterone dose used and/or the level of serum testosterone.

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Is Sex Hormone Priming in Peripubertal Children prior to Growth Hormone Stimulation Tests Still Appropriate?

Cited by 35 publications

References 45 publications

Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

Correlation between Severity of Growth Hormone Deficiency and Thyroid Metabolism and Effects of Long-Term Growth Hormone Treatment on Thyroid Function in Children with Idiopathic Growth Hormone Deficiency

Growth hormone deficiency: diagnosis and therapy in children

Short-term adverse effects of testosterone used for priming in prepubertal boys before growth hormone stimulation test

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