Screening Tests for Growth-Hormone Deficiency in Dwarfism

Hunter, W. M.; Wolfsdorf, Jack; Farquhar, J W; Rigal, W. M.

doi:10.1016/s0140-6736(67)90389-3

Cited by 27 publications

(11 citation statements)

References 10 publications

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“…This finding led to a simple screening before submitting a child to the procedure of insulin hypoglycemia. In accordance with other publications [11,21,36,38,40] we regard the HGH secretion as adequate if a value of over 4 ng/ml is measured in one of the samples without stimulation.…”

Section: Group I: Patients With Growth Retardation and Various Disorderssupporting

confidence: 57%

“…For a correct interpretation of the results, the clinical and other laboratory findings have to be considered. From the known provocative tests like pyrogen [22], lysine vasopressin [18,19], prolonged glucose tolerance [21], arginine infusion [16,20] and insulin hypoglycemia, the latter appears to provide most information. In some cases an additional provocative test based on mechanism of action different from hypoglycemia might be necessary.…”

Section: Resultsmentioning

confidence: 99%

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Experience with Insulin-Induced Hypoglycemia as a Provocative Test for Growth Hormone and Cortisol Secretion in Children

Girard¹,

Baumann²,

Ståhl³

et al. 1971

Horm Res Paediatr

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Insulin-induced hypoglycemia has been used in 109 children with a variety of disorders to assess the hypothalamo-pituitary adrenal axis.The patients were divided into 3 groups: (1) patients with growth retardation and with various disorders where an involvement of the hypothalamo-pituitary region was suspected; (2) obese patients; (3) specific syndromes: spontaneous hypoglycemia, anorexia nervosa, Turner’s syndrome, craniopharyngioma. Glucose, free fatty acids, cortisol and growth hormone were measured before injection of insulin, and at 20-min-intervals thereafter for a period of 2–4 h. The findings, particularly in obesity and in syndromes other than growth disorders have shown, that a series of factors have to be considered for a correct interpretation of the hormonal response to hypoglycemia. The limits for normal, reduced or absent response are given and as a simple screening for growth hormonee deficiency, a growth hormone estimation without stimulation can be used. The test has been found safe under clinical conditions and to provide reliable information about growth hormone and ACTH, respectively cortisol reaction.

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Section: Group I: Patients With Growth Retardation and Various Disorderssupporting

confidence: 57%

Section: Resultsmentioning

confidence: 99%

Experience with Insulin-Induced Hypoglycemia as a Provocative Test for Growth Hormone and Cortisol Secretion in Children

Girard¹,

Baumann²,

Ståhl³

et al. 1971

Horm Res Paediatr

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“…Therefore, the demonstration of subnormal increase in plasma GH concentrations in response to provocative stimulation is necessary to identify GH deficiency states {Hunter, Woltsdorf, Farquhar and Rigal 1967). A number of provocative tests (sleep, physical exercise, hypoglycemia, arginine infusion, glucagon, propranolol and L-dopa) have been described for clinical use but limited information is available in relation to the comparison of these various stimuli (Eddy, Gilliland, Ibarra, McMurray and Thompson 1974).…”

Section: Introductionmentioning

confidence: 99%

Diazepam Test of Growth Hormone Secretion

Kannan¹

1981

Horm Metab Res

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Diazepam induced growth hormone (GH) secretion was studied in six healthy subjects, twenty hypopituitary and five acromegalic patients. Plasma GH, blood glucose and diazepam levels were determined. Diazepam (0.2 mg/kg b.w.) consistently induced GH secretion in control and acromegalic subjects. Oral diazepam produced a peak level (21.2 ± 3.2 ng/ml) at 40 minutes in six control subjects and GH returned to basal levels at 90 minutes (3.8 ±1.2 ng/ml). In twenty hypopituitary subjects with basal GH level of 1.7 ± 0.5 ng/ml, the peak GH after oral diazepam (4.3 ±1.2 ng/ml) was significantly blunted (p < 0.001). In four acromegalic patients, the elevated basal GH level (29.6 ± 9.0 ng/ml) increased further to a peak at 40 minutes (92.7 ± 15.1 ng/ml) and remained high up to 90 minutes (p < 0.001). No GH response was obtained in three hypopituitary and one acromegalic patients.The peak GH level at 20 minutes after intramuscular injection of diazepam (10 mg) was 14.3 ± 3.7 ng/ml in control, 3.0 ± 0.4 ng/ml in five hypopituitary and 54.4 ± 13.1 ng/ml in acromegalic subjects. No significant change in blood glucose was seen after diazepam stimulation. A comparison was made between the GH responses to diazepam and insulin induced hypoglycemia in hypopituitarism and acromegaly. Both tests caused adequate release of GH from the pituitary gland in five control subjects who had normal GH reserve. The peak GH responses of the two tests were similar in magnitude in control subjects and were correlated (r = 0.77; p < 0.001). In five hypopituitary subjects both the tests failed to evoke a satisfactory GH response thus confirming the deficiency of GH. In four acromegaly subjects, diazepam raised serum GH to a higher level than insulin induced hypoglycemia. Diazepam stimulation does not require prior preparation of the patient and is relatively free of side effects. Consequently, we suggest that diazepam induced GH secretion is a simple, reliable test of pituitary function useful in the assessment of hypopituitarism and acromegaly.

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“…They concluded that the peripheral action of the hormone is inhibited in transfusion haemosiderosis. Our patient had a very low fasting level of growth hormone which failed to rise after a glucose meal, strongly suggesting inadequate release of the material from the pituitary [7]. In response to a potent hypoglycaemic stimulus, however, there was a measurable rise in circulating growth hormone levels.…”

Section: Discussionmentioning

confidence: 67%

“…], implying pituitary insufficiency. This appeared to be confirmed by the absence of measura ble growth hormone in a plasma sample taken 3.5 h after an oral glucose load [7]. There was, however, an apparently adequate growth hormone response to insulin hypoglycaemia.…”

Section: Endocrine Investigationsmentioning

confidence: 75%

Endocrine Studies in a Case of Congenital (Erythroid) Hypoplastic Anaemia

Steel¹,

Butterworth²,

Keay³

1972

Acta Haematol

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Congenital (erythroid) hypoplastic anaemia was diagnosed in a newborn male infant whose progress was followed until death at the age of 18 years. He received a total of 456 units of blood and developed obvious transfusion haemosiderosis. He showed total arrest of growth from the age of 9 years and remained sexually infantile. These features are common accompaniments of this haematological disorder. In addition, our patient became severely hypothyroid. Endocrine studies provided limited evidence for an anterior pituitary lesion and at post mortem, the pituitary gland, in common with all the internal organs, was found to contain haemosiderin deposits. The suggestion is made that endocrine features in this condition are secondary to iron overload rather than part of the fundamental disorder. A therapeutic trial of human growth hormone may prove of value in such patients.

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Screening Tests for Growth-Hormone Deficiency in Dwarfism

Cited by 27 publications

References 10 publications

Experience with Insulin-Induced Hypoglycemia as a Provocative Test for Growth Hormone and Cortisol Secretion in Children

Experience with Insulin-Induced Hypoglycemia as a Provocative Test for Growth Hormone and Cortisol Secretion in Children

Diazepam Test of Growth Hormone Secretion

Endocrine Studies in a Case of Congenital (Erythroid) Hypoplastic Anaemia

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