Pegvisomant-primed growth hormone (GH) stimulation test is useful in identifying true GH deficient children

Radetti, Giorgio; Elsedfy, Heba; Khalaf, Randa I.; Meazza, Cristina; Pagani, Sara; Kholy, Mohamed El; Albertini, Riccardo; Stefano, Anna Maria De; Navarra, A.; Silvestri, Annalisa De; Bozzola, Mauro

doi:10.14310/horm.2002.1748

Cited by 3 publications

(4 citation statements)

References 21 publications

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“…A possible solution to these problems may be introduction of new diagnostic tests, such as assessment of GH secretion in stimulation tests after priming with pegvisomant, which results have correlated with IGF-1 levels [22]. Unfortunately, this study has been performed on a relatively small group of children and thus requires further validation.…”

Section: Discrepancies Between Igf-1 Levels and The Results Of Gh Stimulation Testsmentioning

confidence: 99%

“…Next year, Radetti et al [22] have proposed using pegvisomant as a new type of priming enhancing GH secretion, enabling to decrease the rate of false positive results of GH stimulation tests in children. As the study has been performed on a relatively small group of patients, its promising results seem to require further validation.…”

Section: Disregarding Factors Influencing Gh Secretion In Interpreting the Results Of Stimulation Testsmentioning

confidence: 99%

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Inclusion and Withdrawal Criteria for Growth Hormone (GH) Therapy in Children with Idiopathic GH Deficiency—Towards Following the Evidence but Still with Unresolved Problems

Smyczyńska¹

2022

Preprint

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According to current guidelines, growth hormone (GH) therapy is strongly recommended in children and adolescents with GH deficiency (GHD) in order to accelerate growth rate and attain normal adult height. The diagnosis of GHD requires demonstration of decreased GH secretion in stimulation tests, below the established threshold value. Currently, GHD in children is classified as secondary insulin-like growth factor-1 (IGF-1) deficiency. Most of children diagnosed with isolated GHD presents with normal GH secretion at the attainment of near-final height or even in mid-puberty. The most important clinical problems, related to the diagnosis of isolated GHD in children and to optimal duration of rhGH therapy include: arbitrary definition of subnormal GH peak in stimulation tests, disregarding factors influencing GH secretion, insufficient diagnostic accuracy and poor reproducibility of GH stimulation tests, discrepancies between spontaneous and stimulated GH secretion, clinical entity of neurosecretory dysfunction, discrepancies between IGF-1 concentrations and results of GH stimulation tests, significance of IGF-1 deficiency for the diagnosis of GHD, a need for validation IGF-1 reference ranges. Many of these issues have remained unresolved for 25 years or even longer. It seems that finding solutions to them should optimize diagnostics and therapy of children with short stature.

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Section: Discrepancies Between Igf-1 Levels and The Results Of Gh Stimulation Testsmentioning

confidence: 99%

Section: Disregarding Factors Influencing Gh Secretion In Interpreting the Results Of Stimulation Testsmentioning

confidence: 99%

Inclusion and Withdrawal Criteria for Growth Hormone (GH) Therapy in Children with Idiopathic GH Deficiency—Towards Following the Evidence but Still with Unresolved Problems

Smyczyńska¹

2022

Preprint

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“…For research purposes, Radetti et al. reported that priming GHST with Pegvisomant, a GH receptor antagonist, would enhance the accuracy of the test, although this approach has not been extensively confirmed in clinical practice ( 75 ).…”

Section: Use Of Priming In Clinical Practicementioning

confidence: 99%

“…Testicular enlargement and LH increase was more evident with transdermal testosterone preparations. enhance the accuracy of the test, although this approach has not been extensively confirmed in clinical practice (75).…”

Section: Mastromattei Et Al 2022mentioning

confidence: 99%

Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how

et al. 2022

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Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.

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Development of early diagnosis of Parkinson's disease: Illusion or reality?

Ugrumov

2020

CNS Neurosci Ther

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The fight against neurodegenerative diseases, Alzheimer disease and Parkinson's disease (PD), is a challenge of the 21st century. The low efficacy of treating patients is due to the late diagnosis and start of therapy, after the degeneration of most specific neurons and depletion of neuroplasticity. It is believed that the development of early diagnosis (ED) and preventive treatment will delay the onset of specific symptoms. This review evaluates methodologies for developing ED of PD. Since PD is a systemic disease, and the degeneration of certain neurons precedes that of nigrostriatal dopaminergic neurons that control motor function, the current methodology is based on searching biomarkers, such as premotor symptoms and changes in body fluids (BF) in patients. However, all attempts to develop ED were unsuccessful. Therefore, it is proposed to enhance the current methodology by (i) selecting among biomarkers found in BF in patients at the clinical stage those that are characteristics of animal models of the preclinical stage, (ii) searching biomarkers in BF in subjects at the prodromal stage, selected by detecting premotor symptoms and failure of the nigrostriatal dopaminergic system. Moreover, a new methodology was proposed for the development of ED of PD using a provocative test, which is successfully used in internal medicine.

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Pegvisomant-primed growth hormone (GH) stimulation test is useful in identifying true GH deficient children

Cited by 3 publications

References 21 publications

Inclusion and Withdrawal Criteria for Growth Hormone (GH) Therapy in Children with Idiopathic GH Deficiency—Towards Following the Evidence but Still with Unresolved Problems

Inclusion and Withdrawal Criteria for Growth Hormone (GH) Therapy in Children with Idiopathic GH Deficiency—Towards Following the Evidence but Still with Unresolved Problems

Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how

Development of early diagnosis of Parkinson's disease: Illusion or reality?

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