scholarly journals Comparative study of glucagon and insulin tests for diagnostics of secondary adrenal insufficiency and growth hormone deficiency in children and adolescents

2021 ◽  
Vol 66 (6) ◽  
pp. 50-58
Author(s):  
A. V. Vitebskaya ◽  
E. A. Pisareva ◽  
A. V. Popovich
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Early Morning ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency ◽  
Glucagon Test ◽  
Cortisol Levels ◽  
Glucagon And Insulin

BACKGROUND: Diagnostics of growth hormone deficiency (GHD) and secondary adrenal insufficiency (SAI) is based on estimation of peak GH and cortisol concentrations in provocation tests. Russian consensus on diagnostics and treatment of hypopituitarism in children and adolescences recommends to measure GH and cortisol concentrations in every time-point of insulin test (IT). Glucagon test (GT) is discussed in literature as alternative to IT.AIMS: To estimate the possibility to use provocation GT for diagnostics of SAI and GHD in children and adolescents.MATERIALS AND METHODS: We investigated blood and urine cortisol levels, IT, and GT in 20 patients 6.5–17.8 years (Me 13.0 (10.4; 15.3)) after surgery and/or radiology and/or chemical therapy of head and neck tumors; remission for 0.4–7.5 years (Ме 2.1 (1.5; 5.2)).RESULTS: With cut-off point 550 nmol/L sensitivity and specifity of IT was 100% and 60%, GT — 100% and 53% respectively. Minimal cortisol cut-off level for GT with sensitivity 100% was 500 nmol/L, maximal with specifity 100% — 400 nmol/L.Early morning cortisol levels did not exceed 250 nmol/l in 2 patients with SAI; and were above 500 nmol/l in 8 patients without SAI while primary or repeated examination.GHD was reviled by IT in all patients. Maximal GH concentrations in GT and IT did not differ significantly (p>0.05) but GT results of 4 patients exceeded or met cut-off for this test (7 ng/ml).GT was characterized by less severity compared with IT.CONCLUSIONS: For diagnostics of SAI by GT we can advise cut-off points of cortisol level 500 (sensitivity 100%, specifty 53%) and 400 nmol/L (sensitivity 80%, specifity 100%). Measuring of cortisol levels in 2–3 early morning blood samples allows to exclude or to suspect SAI in half of patients before tests. GH peaks in GT can exceed similarly data in IT that needs future investigation. 

scholarly journals Secondary Adrenal Insufficiency and Growth Hormone Deficiency in Patients with Fibromyalgia

2021 ◽  
Vol Volume 14 ◽  
pp. 1323-1329
Author(s):  
Lucinda M Gruber ◽  
Sanjeev Nanda ◽  
Todd Nippoldt ◽  
Alice Chang ◽  
Irina Bancos
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Hormone Deficiency ◽  
Secondary Adrenal Insufficiency

scholarly journals Self-Esteem in Children and Adolescents with Growth Hormone Deficiency

2018 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Héla Ayadi ◽  
Leila Cherif ◽  
Imen Hadjkacem ◽  
Wiem Kammoun ◽  
Khaoula Khemakhem ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Self Esteem ◽  
Hormone Deficiency

Isolated Growth Hormone Deficiency in Children and Adolescents

2001 ◽  
Vol 14 (s2) ◽  
Author(s):  
J. Argente ◽  
S.A.S. Abusrewil ◽  
G. Bona ◽  
F. Chiarelli ◽  
C.J.H. Kelnar ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Transcription Factor ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Hormonal Regulation ◽  
Human Growth ◽  
Hormone Deficiency ◽  
Imaging Method ◽  
Gh Secretion ◽  
Definition Of

AbstractAlthough it is difficult to reach international agreement on the definition of growth hormone deficiency (GHD) in children and adolescents, great efforts to do so have been made during the last two decades. A somewhat limited definition of GHD is: a combination of auxological, clinical, biochemical and metabolic abnormalities caused by lack or insufficiency of GH secretion that results in a decrease in the production of GH-dependent hormones and growth factors. Its aetiology is very complex. Therefore, specific studies must be performed during different periods of childhood (neonatal, prepubertal and pubertal periods). Auxological parameters, particularly growth velocity (GV), are still considered the best clinical measures for analysing human growth. The spectacular advances in our understanding of molecular biology during the past twenty years have allowed, and will continue to allow, a more and more precise diagnosis of the molecular anomalies of human growth. This will, in turn, allow changes caused by genetic lesions to be more efficiently distinguished from those due to nutritional, organic, tumoural, psychological or traumatic causes. Our knowledge of the molecular bases of undergrowth due to a deficiency in GH has developed as a result of the localisation and characterisation of human genes which code for proteins implicated in the hormonal regulation of growth. These genes include pituitary GH (GH1), pituitary transcription factor 1 (Pit-1), the prophet of Pit-1 (PROP-1), the pituitary; transcription factor LHX3, the transcription factor HESX1 and the GH-releasing hormone receptor (GHRHr). In addition, magnetic resonance imaging is the best available imaging method for the evaluation of size and structure of the pituitary and the parasellar region.

scholarly journals SUN-457 Congenital Growth Hormone Deficiency Associated with Hip Disorders in Children and Adolescents

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Elisa Baranski Lamback ◽  
Stella Chiarini ◽  
Andreas Roposch ◽  
Mehul Dattani
Keyword(s):  
Growth Hormone ◽  
Children And Adolescents ◽  
Growth Hormone Deficiency ◽  
Hormone Deficiency

scholarly journals Evaluation of adrenal function in patients with growth hormone deficiency and hypothalamic–pituitary disorders: comparison between insulin-induced hypoglycemia, low-dose ACTH, standard ACTH and CRH stimulation tests

2005 ◽  
Vol 152 (5) ◽  
pp. 735-741 ◽  
Author(s):  
M Maghnie ◽  
E Uga ◽  
F Temporini ◽  
N Di Iorgi ◽  
A Secco ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Adrenal Insufficiency ◽  
Low Dose ◽  
Clinical Symptoms ◽  
Adrenal Function ◽  
Hormone Deficiency ◽  
Cortisol Response ◽  
Normal Response ◽  
Morning Cortisol

Objectives: Patients with organic growth hormone deficiency (GHD) or with structural hypothalamic–pituitary abnormalities may have additional anterior pituitary hormone deficits, and are at risk of developing complete or partial corticotropin (ACTH) deficiency. Evaluation of the integrity of the hypothalamic–pituitary–adrenal axis (HPA) is essential in these patients because, although clinically asymptomatic, their HPA cannot appropriately react to stressful stimuli with potentially life-threatening consequences. Design and methods: In this study we evaluated the integrity of the HPA in 24 patients (age 4.2–31 years at the time of the study) with an established diagnosis of GHD and compared the reliability of the insulin tolerance test (ITT), short synacthen test (SST), low-dose SST (LDSST), and corticotropin releasing hormone (CRH) test in the diagnosis of adrenal insufficiency. Results: At a cortisol cut-off for a normal response of 550 nmol/l (20 μg/dl), the response to ITT was subnormal in 11 subjects, 6 with congenital and 5 with acquired GHD. Four patients had overt adrenal insufficiency, with morning cortisol concentrations ranging between 66.2–135.2 nmol/l (2.4–4.9 μg/dl) and typical clinical symptoms and laboratory findings. In all these patients, a subnormal cortisol response to ITT was confirmed by LDSST and by CRH tests. SST failed to identify one of the patients as adrenal insufficient. In the seven asymptomatic patients with a subnormal cortisol response to ITT, the diagnosis of adrenal insufficiency was confirmed in one by LDSST, in none by SST, and in five by CRH tests. The five patients with a normal cortisol response to ITT exhibited a normal response also after LDSST and SST. Only two of them had a normal response after a CRH test. In the seven patients with asymptomatic adrenal insufficiency mean morning cortisol concentration was significantly higher than in the patients with overt adrenal insufficiency. ITT was contraindicated in eight patients, and none of them had clinical symptoms of overt adrenal insufficiency. One of these patients had a subnormal cortisol response to LDSST, SST, and CRH, and three exhibited a subnormal response to CRH but normal responses to LDSST and to SST. Conclusion: We conclude that none of these tests can be considered completely reliable for establishing or excluding the presence of secondary or tertiary adrenal insufficiency. Consequently, clinical judgment remains one of the most important issues for deciding which patients need assessment or re–assessment of adrenal function.

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