New approach to the diagnosis of growth hormone deficiency in adults

Ghigo, Ezio; Aimaretti, Gianluca; Gianotti, Laura; Bellone, J.; Arvat, Emanuela; Camanni, F.

doi:10.1530/eje.0.1340352

Cited by 245 publications

(170 citation statements)

References 12 publications

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“…29,42,43 On the other hand, testing with GHRH arginine, which strongly potentiates the GH-releasing effect of the neurohormone allowing for the evaluation of the maximal secretory capacity of somatotrope cells, 29 has been found reliable in distinguishing between normal and GHD subjects. 30 The results of the present study con®rm that GHRH arginine is a potent stimulatory test of the maximal secretory capacity of somatotrope cells and, noteworthy, demonstrate that it has good intraindividual reproducibility thus strengthening its reliability. The minimum normal limit of GH peak response to this test (16.5 mg/l) is higher than those arbitrarily assigned for other provocative stimuli and allows to clearly show that patients with organic GHD have subnormal GH response distinguishing them from normal subjects.…”

Section: Discussionsupporting

confidence: 68%

“…25 The assay of IGF-I and IGFBP-3 as well as the evaluation of spontaneous GH secretion have been found unreliable to distinguish between normal subjects and GHD patients. 25,30 Insulin-induced hypoglycemia has been indicated as the golden standard test by some authors 25 but not by others. 29,42,43 On the other hand, testing with GHRH arginine, which strongly potentiates the GH-releasing effect of the neurohormone allowing for the evaluation of the maximal secretory capacity of somatotrope cells, 29 has been found reliable in distinguishing between normal and GHD subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Dotted line at 16.5 mg/l indicates lowest normal peak GH response. 30 Dotted line at 3.0 mg/l indicates the peak GH response under which severe GHD is shown and rhGH replacement is allowed. 31 treatment with rhGH.…”

Section: Discussionmentioning

confidence: 99%

“…26 More recently, testing with GHRH combined with arginine, which likely acts via inhibition of hypothalamic somatostatin release and potentiates the GH response to the neurohormone, 28,29 has been proposed as the best way to explore the maximal secretory capacity of somatotrope cells and to distinguish between normal subjects and GH de®cient patients. 30 At present, there is consensus about the fact that rhGH replacement therapy is allowed only for GHD patients presenting with GH peak response lower than 3 mg/l after provocative stimulation. 31 Based on the foregoing, the aim of the present study was to verify the extent of GH insuf®ciency in obesity evaluating the maximal secretory capacity of somatotrope by testing with GHRH arginine; the results in obese patients were compared with those in patients with organic GH de®ciency and in normal controls.…”

Section: Introductionmentioning

confidence: 99%

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Maximal secretory capacity of somatotrope cells in obesity: comparison with GH deficiency

et al. 1997

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OBJECTIVE: To evaluate the maximal secretory capacity of somatotrope cells in obesity and to compare it with that in hypopituitaric patients with GH de®ciency. DESIGN: Stimulation with GHRH. (1 mg/kg iv) combined with arginine (ARG, 0.5 g/kg iv), which strongly potentiates the GH response to the neurohormone, likely inhibiting hypothalamic somatostatin. The reproducibility of the GH response to GHRH ARG was evaluated in a second session. SUBJECTS: Forty-®ve patients with simple obesity (OB 11 male and 34 female, age 40.5 AE AE 1.8 y, BMI 38.8 AE AE 1.1 kg/m 2 ), 49 patients with hypopituitarism (GHD, 23 male and 26 female, 43.6 AE AE 2.4 y, 24.7 AE AE 0.7 kg/m 2 ) and 44 normal young volunteers (NS, 25 male and 19 female, 33.8 AE AE 1.0 y, 21.6 AE AE 0.3 kg/m 2 ) were studied. MEASUREMENTS: GH levels were assayed by IRMA method, basally at 7 60 and 0 min, and than every 15 min up to 120 min. Basal IGF±I levels were assayed by RIA method, after acid-ethanol extraction. RESULTS: IGF±I levels in OB were lower (P`0.005) than those in NS but higher (P`0.005) than those in GHD. Mean peak GH response to GHRH ARG in OB was clearly lower than that in NS (P`0.005) and higher (P`0.005) than that in GHD. Sixty±percent OB and 100% GHD showed peak GH responses lower than the minimum normal limit in NS (16.5 mg/l) while 4% OB and only 53% GHD with GH responses lower than 3 mg/l, the limit under which GH replacement therapy of severe de®ciency is allowed. Good intraindividual reproducibility of the GH response to GHRH arginine test was present in all groups (OB: r 0.78, P`0.0001; GHD: r 0.57, P`0.003; NS: r 0.74, P`0.0001;. CONCLUSIONS: The maximal secretory capacity of somatotrope cells is clearly less than normal in the obese but still more than is seen in GHD subjects. However, in about 50% of obese patients, the pituitary GH releasable pool overlaps with that of hypopituitaric patients with GH de®ciency. Thus, even when the maximal secretory capacity of somatotrope cells is evaluated by a potent and reproducible provocative tests such as GHRH arginine, overweight has to be taken in a great account as the cause of severely impaired GH response in patients with suspected GH de®ciency.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Maximal secretory capacity of somatotrope cells in obesity: comparison with GH deficiency

et al. 1997

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“…However, this reliability declines with age and Toogood et al found that only 21% of elderly GHD patients (aged 61-85 years) had a serum IGF1 lower than age-matched controls (22). Therefore, in a young patient IGF1 SDS may be helpful in indicating the presence of GHD, whereas in middle-aged or older patients it is less useful unless unequivocally low in the absence of intercurrent illness and hepatic dysfunction (23)(24)(25).…”

Section: Diagnosismentioning

confidence: 99%

Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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It is now accepted that adults with severe GH deficiency (GHD) demonstrate impaired physical and psychological well-being and may benefit from replacement with recombinant human GH. Postmarketing surveillance surveys, such as the Pfizer International Metabolic Database (KIMS), were initially set-up to provide safety data on long-term treatment but have the added benefit of providing ongoing observational data on the effect of GH replacement on body composition, lipid and glucose status, hypertension, bone density and quality of life. These data demonstrate that although GHD has clinical impact at all ages, the individual consequences of this condition may take on greater significance at different stages in life. At all ages, accurate, safe diagnosis and appropriate GH dosing are necessary to provide the individual with the best possible outcome.

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Hormone Replacement Therapy

Janssen

Lely

Rogol

et al. 2013

Pituitary Disorders

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vaccinationists, it is important to understand that they have deeply held beliefs, often of a spiritual or philosophical nature, 11 and these beliefs have remained remarkably constant over the better part of two centuries. The movement encompasses a wide range of individuals, from a few who express conspiracy theories, to educated, well informed consumers of health care, who often have a complex rationale for their beliefs, related to a "mixture of world views held about the environment, healing, holism. .. and a critical reading of the scientific and alternative literature." 12 Vaccination is unique among de facto mandatory requirements in the modern era, requiring individuals to accept the injection of a medicine or medicinal agent into their bodies, and it has provoked a spirited opposition. This opposition began with the first vaccinations, has not ceased, and probably never will. From this realisation arises a difficult issue: how should the mainstream medical authorities approach the anti-vaccination movement? A passive reaction could be construed as endangering the health of society, whereas a heavy handed approach can threaten the values of individual liberty and freedom of expression that we cherish. This creative tension will not leave us and cannot be cured by force alone.

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New approach to the diagnosis of growth hormone deficiency in adults

Abstract: New approach to the diagnosis of growth hormone deficiency in adults. Eur J Endocrinol 1996;134:352-6. Pyridostigmine (PD), a muscarinic cholinergic agonist, and arginine (ARG) clearly increase the growth hormone (GH) response to growth hormone-releasing hormone (GHRH)

Cited by 245 publications

References 12 publications

Maximal secretory capacity of somatotrope cells in obesity: comparison with GH deficiency

Maximal secretory capacity of somatotrope cells in obesity: comparison with GH deficiency

Adult GH deficiency throughout lifetime

Hormone Replacement Therapy

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