Is maternal growth hormone essential for a normal pregnancy?

OBJECTIVE: It remains uncertain whether there is any disadvantage imposed upon women with pituitary disease who are GH-deficient and become pregnant. The aim of this study was to determine whether maternal GH deficiency adversely affects the outcome of pregnancy. DESIGN: Retrospective study. METHODS: The case notes of 77 female patients with known GH deficiency were examined. Sixteen patients (a total of 25 pregnancies) were identified who had been pregnant whilst known to be GH-deficient. Peak GH response to provocative testing prior to pregnancy, length of gestation, birth weight, maternal well-being and the incidence of maternal and fetal complications of pregnancy were documented. RESULTS: Peak GH response to insulin tolerance test (n = 21 ) or glucagon stimulation test (n = 4) prior to pregnancy was 8.7 (< 1 to 17.3)mU/l (peak < or =9 mU/l in 14 cases). There were 25 pregnancies resulting in 26 live births (including one set of twins and one set of quins) and 4 spontaneous first trimester abortions. Eight pregnancies were achieved by ovulation induction. Median gestation of live births was 39 (33 to 42) weeks. Median birth weight excluding multiple births (n = 19), uncorrected for gestational age, was 3.09 (1.64 to 4.19) kg, and the numbers with birth weights below the 10th, between the 10th and 90th, and above the 90th centiles were five, nine and five respectively. Preeclampsia occurred in two pregnancies and post-partum haemorrhage after one pregnancy. There were three minor congenital abnormalities. CONCLUSIONS: Our data suggest that pregnancy in GH-deficient females is not detrimental to the fetus and the incidence of maternal morbidity is low. We conclude that GH replacement therapy is probably not essential for GH-deficient females during pregnancy.

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TO STUDY THE CONSEQUENCES OF TEENAGE PREGNANCY- MATERNAL AND PERINATAL OUTCOME IN TERTIARY CARE CENTER

10.36106/5100956 ◽

2021 ◽

pp. 22-25

Author(s):

Yogesh Thawal ◽

Meenal M. Patvekar ◽

Prashant Suryarao ◽

Dipak Suresh Kolate ◽

Shayari Jain ◽

...

Keyword(s):

Birth Weight ◽

Teenage Pregnancy ◽

Post Partum ◽

Care Center ◽

Tertiary Care ◽

First Trimester ◽

Tertiary Care Center ◽

College Hospital ◽

Live Births ◽

Normal Birth

Background: Teenage pregnancies are associated with high degree of maternal and neonatal complications. As many adolescents are neither physically nor psychologically ready for pregnancy or childbirth, this reproductive event makes them more vulnerable to complications resulting in devastating health sequences for them. Objectives: Our objective is to study feto-maternal outcomes in teenage pregnancy for betterment of society & for abetting economic burden on country. This observational Materials & Methods: study was done over 2 years at our tertiary care center - Dr DY Patil Medical College, Hospital and Research Institute, Pimpri, Pune. A total of 205 participants were included in the study after obtaining informed consent from the patients who satised the inclusion of age more than or equal to 18 years and lesser than 20 years. Operative interventions like D&E Results : , LSCS were increased in teenage pregnancies with emergency LSCS in 36.58% of the participants. First trimester & Antepartum complications were common in teenage pregnancies. Even Intrapartum & Post partum complications were contributed signicantly to feto-maternal morbidity & mortality . 54.04% had low birth weight and only 40.91% had normal birth weight. A total 64 NICU admissions were needed from 193 live births. Of these 12 expired in early neonatal period (<7 days) whereas 7 expired between 7 to 28 days. Among those who survived, almost 40 % had perinatal hypoxia. There were 96.98% live births whereas 3.01% IUD. Conclusion : Teenage pregnancy is a condition which gives rise to further complications and affects both the maternal as well as the neonatal health. Hence it is important that at every level of the society there is awareness regarding sexual education, use of contraceptives and the ill effects of teenage pregnancy.

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Influence of Body Mass Index and Gender on Growth Hormone (GH) Responses to GH-Releasing Hormone Plus Arginine and Insulin Tolerance Tests

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-1450 ◽

2005 ◽

Vol 90 (3) ◽

pp. 1563-1569 ◽

Cited By ~ 60

Author(s):

Xiao-Dan Qu ◽

Irene T. Gaw Gonzalo ◽

Mohammed Y. Al Sayed ◽

Pejman Cohan ◽

Peter D. Christenson ◽

...

Keyword(s):

Body Mass Index ◽

Gender Differences ◽

Body Mass ◽

Healthy Subjects ◽

Gh Deficiency ◽

Tolerance Test ◽

Insulin Tolerance Test ◽

Insulin Tolerance ◽

Stimulation Tests ◽

And Gender

The aim of this study is to assess whether gender and body mass index (BMI) should be considered in developing thresholds to define GH deficiency, using GH responses to GHRH + arginine (ARG) stimulation and insulin tolerance test (ITT). Thirty-nine healthy subjects (19 males, 20 females; ages 21–50 yr) underwent GHRH + ARG, and another 27 subjects (19 males, 8 females; ages 20–49 yr) underwent ITT. Peak GH response was significantly higher (P = 0.005) after GHRH + ARG than with ITT, and this difference could not be explained by age, gender, or BMI. Peak GH response was negatively correlated with BMI in both tests (GHRH + ARG, r = −0.76; and ITT, r = −0.65). Peak GH response to GHRH + ARG was higher in females than males (P = 0.004; ratio = 2.4), but it was attenuated after eliminating the influence of BMI (P = 0.13; ratio = 1.6). No significant gender differences were found in peak GH responses to ITT, which could be due to the smaller number of female subjects studied. GH response to GHRH + ARG and ITT stimulation is sensitive to BMI differences and less so to gender differences. A higher BMI is associated with a depressed GH response to both stimulation tests. BMI should therefore be considered as a factor when defining the diagnostic cut-off points in the assessment of GH deficiency, whereas whether gender should be likewise used is inconclusive from this study.

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Cut-off limits of the peak GH response to stimulation tests for the diagnosis of GH deficiency in children and adolescents: study in patients with organic GHD

Acta Endocrinologica ◽

10.1530/eje-16-0105 ◽

2016 ◽

Vol 175 (1) ◽

pp. 41-47 ◽

Cited By ~ 16

Author(s):

Chiara Guzzetti ◽

Anastasia Ibba ◽

Sabrina Pilia ◽

Nadia Beltrami ◽

Natascia Di Iorgi ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Children And Adolescents ◽

Roc Analysis ◽

Operating Characteristic ◽

Gh Deficiency ◽

Tolerance Test ◽

Gh Secretion ◽

Insulin Tolerance ◽

Igf I ◽

Stimulation Tests

ObjectiveThe diagnosis of GH deficiency (GHD) in children and adolescents is established when GH concentrations fail to reach an arbitrary cut-off level after at least two provocative tests. The objective of the study was to define the optimal GH cut-offs to provocative tests in children and adolescents.DesignRetrospective study in 372 subjects who underwent evaluation of GH secretion. GH and IGF-I were measured by chemiluminescence assay in all samples. Receiver operating characteristic (ROC) analysis was used to evaluate the optimal GH cut-offs and the diagnostic accuracy of provocative tests.MethodsSeventy four patients with organic GHD (GH peak <10μg/L after two provocative tests) and 298 control subjects (GH response >10μg/L to at least one test) were included in the study. The provocative tests used were arginine, insulin tolerance test (ITT) and clonidine. Diagnostic criteria based on cut-offs identified by ROC analysis (best pair of values for sensitivity and specificity) were evaluated for each test individually and for each test combined with IGF-I SDS.ResultsThe optimal GH cut-off for arginine resulted 6.5μg/L, 5.1μg/L for ITT and 6.8μg/L for clonidine. IGF-I SDS has low accuracy in diagnosing GHD (AUC=0.85). The combination of the results of provocative tests with IGF-I concentrations increased the specificity.ConclusionsThe results of the ROC analysis showed that the cut-off limits which discriminate between normal and GHD are lower than those commonly employed. IGF-I is characterized by low diagnostic accuracy.

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Test of growth hormone secretion in adults: poor reproducibility of the insulin tolerance test

Acta Endocrinologica ◽

10.1530/eje.0.1330305 ◽

1995 ◽

Vol 133 (3) ◽

pp. 305-312 ◽

Cited By ~ 78

Author(s):

Hans C Hoeck ◽

Peter Vestergaard ◽

Poul E Jakobsen ◽

Peter Laurberg

Keyword(s):

Growth Hormone ◽

Gh Deficiency ◽

Hormone Secretion ◽

Growth Hormone Secretion ◽

Tolerance Test ◽

Insulin Tolerance Test ◽

Repeated Testing ◽

Provocative Test ◽

Insulin Tolerance ◽

Gh Deficiency In Adults

Hoeck HC, Vestergaard P, Jakobsen PE, Laurberg P, Test of growth hormone secretion in adults: poor reproducibility of the insulin tolerance test. Eur J Endocrinol 1995;133:305–12. ISSN 0804–4643 The insulin tolerance test (ITT) is regarded as the most reliable provocative test in the diagnosis of growth hormone (GH) deficiency in adults. In the present study the test was evaluated by investigating the range of GH responses in normal adult males and females and the intra-individual reproducibility of the test. Sixteen healthy non-obese adults, eight males (median age 31.5 years) and eight females (median age 31.8 years) were tested twice with the ITT, with a minimum of 72 h between each test. The females were tested between day 3 and day 10 of their menstrual cycles. Adequate hypoglycemia was achieved in all cases with a median nadir blood glucose of 1.3 mmol/l (range 0.8–2.0). Growth hormone in serum was measured by immunoradiometric assay and low values were confirmed by a different assay. Median peak GH concentration responses to the ITT were: in males 27.9 μg/l, range 5.0–71.1 (test 1) and 30.5 μg/l, range 7.9–69.5 (test 2); and in females 9.0 μg/l, range 4.1–17.9 (test 1) and 8.4 μg/l, range 0.09–42.4 (test 2). The rise in GH concentration during the ITT was higher in males than in females. In the males, all stimulated GH values were ≥5.0 μg/l. In the females, four out of 16 tests gave values below 5.0 μg/l and in one test the GH value was around the detection limit of the assays. There was poor reproducibility during repeated testing, with no correlation between the results of the two tests. The results did not correlate to the magnitude of the hypoglycemia. The results of this study illustrate the complexity of the regulation of GH secretion and indicate that the ITT is less useful for diagnosing GH deficiency in adults than previously anticipated. The diagnosis of GH deficiency in adults and especially in adult females should not be based on the results of a single ITT alone. Hans C Hoeck, Department of Endocrinology, Aalborg Regional Hospital, Reberbansgade, DK-9000 Aalborg, Denmark

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The arginine and GHRP-2 tests as alternatives to the insulin tolerance test for the diagnosis of adult GH deficiency in Japanese patients: A comparison

Endocrine Journal ◽

10.1507/endocrj.ej12-0230 ◽

2013 ◽

Vol 60 (1) ◽

pp. 97-105 ◽

Cited By ~ 5

Author(s):

Yasuyuki Kinoshita ◽

Atsushi Tominaga ◽

Satoshi Usui ◽

Kazunori Arita ◽

Tetsuhiko Sakoguchi ◽

...

Keyword(s):

Gh Deficiency ◽

Japanese Patients ◽

Tolerance Test ◽

Insulin Tolerance Test ◽

Insulin Tolerance ◽

Adult Gh Deficiency

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Update on the diagnosis of GH deficiency in adults

Acta Endocrinologica ◽

10.1530/eje.0.148s003 ◽

2003 ◽

pp. S3-S8 ◽

Cited By ~ 18

Author(s):

R Abs

Keyword(s):

Gh Deficiency ◽

Tolerance Test ◽

Cranial Irradiation ◽

Pituitary Hormone ◽

Childhood Onset ◽

Gh Secretion ◽

Insulin Tolerance ◽

Stimulation Tests ◽

History Of ◽

Considerable Morbidity

GH deficiency (GHD) in adults is associated with considerable morbidity and mortality. The diagnosis of GHD is generally straightforward in children as growth retardation is present; however, in adults, diagnosis of GHD is often challenging. Other markers are therefore needed to identify adults who have GHD and could potentially benefit from GH replacement therapy. Consensus guidelines for the diagnosis and treatment of adult GHD recommend provocative testing of GH secretion for patients who have evidence of hypothalamic-pituitary disease, patients with childhood-onset GHD, and patients who have undergone cranial irradiation or have a history of head trauma. Suspicion of GHD is also heightened in the presence of other pituitary hormone deficits. Tests for GHD include measurement of the hormone in urine or serum or measurement of stimulated GH levels after administration of various provocative agents. The results of several studies indicate that non-stimulated serum or urine measurements of GH levels cannot reliably predict deficiency in adults. Although glucagon and arginine tests produce a pronounced GH response with few false positives, the insulin tolerance test (ITT) is currently considered to be the gold standard of the GH stimulation tests available. Unfortunately, the ITT has some disadvantages and questionable reproducibility, which have prompted the development of several new tests for GHD that are based on pharmacological stimuli. Of these, GH-releasing hormone (GHRH) plus arginine and GHRH plus GH-releasing peptide (GHRP) appear to be reliable and practical. Thus, in cases where ITT is contraindicated or inconclusive, the combination of arginine and GHRH is an effective alternative. As experience with this test as well as with GHRH/GHRP-6 accumulates, they may supplant ITT as the diagnostic test of choice.

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A STUDY OF MATERNAL AND PERINATAL OUTCOME IN POST DATED PREGNANCY

10.36106/gjra/7006869 ◽

2020 ◽

pp. 1-3

Author(s):

Puja verma ◽

Vinita Kumari ◽

Dipti Roy

Keyword(s):

Birth Weight ◽

Perinatal Outcome ◽

Post Partum ◽

Fetal Outcome ◽

Age Group ◽

Term Pregnancy ◽

Fetal Complications ◽

The Mean ◽

Labour Room ◽

Post Term Pregnancy

When pregnancy goes beyond 40 weeks it is called post dated pregnancy. The incidence of post term pregnancy varies from 3-12%1,2. Post term or post dated pregnancies are associated with various maternal and fetal complications. A total of 80 women attending labour room emergency with post dated pregnancy (<40 weeks) were recruited for the study. This study was done to observe the maternal and fetal outcome in post dated pregnancies. The mean age was 23.14±2.2 years. Maximum women were in the age group of 20-30 years (67.5%). More than 50% had meconium stained liquor whereas 42.5% had clear liquor. A birth weight more than 3 kg was observed in 21 babies which was 26.25 % and maximum of 53 babies (66.25%) had birth weight between 2.5 kg and 3 kg. Only 6 babies had birth weight less than 2.5 kg. Ten babies were admitted to NICU. Thus, post dated pregnancies require strict vigilance during antepartum, intrapartum and post partum period due to increased incidence of complications.

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Acylated ghrelin as a provocative test for the diagnosis of GH deficiency in adults

Acta Endocrinologica ◽

10.1530/eje-12-0584 ◽

2013 ◽

Vol 168 (1) ◽

pp. 23-30 ◽

Cited By ~ 20

Author(s):

Valentina Gasco ◽

Guglielmo Beccuti ◽

Chiara Baldini ◽

Nunzia Prencipe ◽

Stellina Di Giacomo ◽

...

Keyword(s):

Gh Deficiency ◽

Characteristic Curve ◽

Tolerance Test ◽

Acylated Ghrelin ◽

Diagnostic Reliability ◽

Provocative Test ◽

Insulin Tolerance ◽

History Of ◽

The One ◽

Overweight Subjects

ObjectiveInsulin tolerance test (ITT) is the test of reference for the diagnosis of adult GH deficiency (GHD), although GHRH in combination with arginine (ARG) or GH secretagogues are considered equally reliable tests. Testing with GH secretagogue alone is, anyway, a potent stimulus exploring the integrity of hypothalamic pathways controlling somatotropic function. We therefore aimed to determine the diagnostic reliability of testing with ghrelin, the natural GH secretagogue.MethodsWe studied the GH response (every 15 min from −15 to +120 min) to acylated ghrelin (1 μg/kg i.v. at 0 min) in 78 patients with a history of pituitary disease (49 male, 29 female; age (mean±s.d.): 52.1±18.7 years; BMI: 26.7±5.3 kg/m2). The lack of GH response to GHRH+ARG and/or ITT was considered the gold standard for the diagnosis of GHD. The best GH cut-off to ghrelin test, defined as the one with the best sensitivity (SE) and specificity (SP), was identified using the receiver-operating characteristic curve analysis.ResultsThe best GH cut-off to ghrelin test was 7.3 μg/l in lean subjects (SE 88.2%, SP 90.9%), 2.9 μg/l in overweight subjects (SE 92.6%, SP 100%) and 0.6 μg/l in obese subjects (SE 50%, SP 100%). The diagnostic accuracy was 89.3, 94.1 and 62.5% respectively.ConclusionsOur data show that testing with acylated ghrelin represents a reliable diagnostic tool for the diagnosis of adult GHD, in lean and overweight subjects, if appropriate cut-off limits are assumed. Obesity strongly reduces GH response to ghrelin, GH weight-related cut-off limit and diagnostic reliability of the test.

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Hyperthyroidism and Its Implications for Diagnosis and Management of Complications During Pregnancy

BioScientific Review ◽

10.32350/bsr.0201.05 ◽

2020 ◽

Vol 2 (1) ◽

pp. 40-49

Author(s):

Farah Kausar

Keyword(s):

Pregnant Women ◽

Post Partum ◽

First Trimester ◽

Successful Pregnancy ◽

Management Guidelines ◽

Management Of Complications ◽

Fetal Complications ◽

Women Literature ◽

Thyroid Receptor ◽

Receptor Antibodies

Thyroid dysfunction alters the physiological events of pregnancy that may have serious outcomes if left untreated. Hyperthyroidism (a thyroid disease) is related to complications during pregnancy. A challenging task for the physician is to correctly diagnose and properly manage hyperthyroidism in pregnant women. Hyperthyroidism is an autoimmune disease caused by excessive production of thyroxin hormone. The objective of this paper is to review the research in detection and management of Graves’ disease (thyrotoxicosis) during and after pregnancy. This paper discusses thyroid receptor antibodies, etiology of Grave’s disease (thyrotoxicosis), pregnancy related complications, infants’ thyrotoxicosis management, as well as post-partum management, guidelines and counseling offered to pregnant women. Literature search was conducted using the keyword ‘hyperthyroidism’ in conjunction with pregnancy, anti-thyroid drugs and birth defects in Pubmed, Google Scholar and Medline. Maintaining thyroid gland may reduce the complications of pregnancy. At the beginning of pregnancy, low doses of anti-thyroid drugs are usually recommended to women by endocrinologists. However, the use of these drugs is completely stopped after 4 – 8 weeks of gestation. Propylthiouracil is the preferred anti-thyroid drug used in the first trimester in case of preconception to decrease the risk of teratogenicity. Carbimazole may be used in the first three months. Early diagnosis and maintaining normal hormone concentration by reducing the level of thyroid receptor antibodies as well as anti-thyroid drugs is essential in order to prevent maternal and fetal complications. Counseling and guidelines provided by endocrinologists constitute the key to a healthy and successful pregnancy.

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SUN-307 Partial Secondary Adrenal Insufficiency and Growth Hormone Deficiency in Fibromyalgia

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.922 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Lucinda Gruber ◽

Sanjeev Nanda ◽

Todd B Nippoldt ◽

Alice Y Chang ◽

Irina Bancos

Keyword(s):

Adrenal Insufficiency ◽

Gh Deficiency ◽

Tolerance Test ◽

Insulin Tolerance Test ◽

Cortisol Concentration ◽

Stimulation Test ◽

Gh Replacement ◽

Insulin Tolerance ◽

Morning Cortisol ◽

Cosyntropin Stimulation Test

Abstract Introduction: Low or borderline cortisol concentrations and impaired response to dynamic testing have been reported in patients with fibromyalgia, potentially related to hypothalamus-pituitary dysfunction.1,2 Superimposed adrenal insufficiency (AI) may contribute to some fibromyalgia symptoms or delay improvement in patients enrolled in fibromyalgia treatment programs. We hypothesized that a subset of patients with fibromyalgia have: 1) partial secondary AI and concomitant growth hormone (GH) deficiency 2) a discordance in Cosyntropin stimulation test and 3) improvement in fibromyalgia symptoms with initiation of glucocorticoid and/or GH replacement. Design: This was a retrospective study of patients with fibromyalgia diagnosed with partial secondary AI based on abnormal insulin tolerance test (peak cortisol < 18 mcg/dL) at our institution from June 2002 to August 2019. Patients were excluded if they had other reasons for adrenal insufficiency, including steroid exposure and opioid use. Results: We identified 22 patients (18 women, 82%) diagnosed with partial AI at a median age of 38 years (range 19-65). The fibromyalgia symptoms included fatigue (n=22, 100%), pain (n=22, 100%), sleep disturbance (n=15, 68%), and bowel changes (n=13, 59%). The median morning cortisol concentration was 8.6 mcg/dL (range 1.1-11); 9 patients (41%) had a morning cortisol concentration below the normal range (7 mcg/dL). The median ACTH level was 15.5 pg/mL (range 7.7-54). Nineteen patients had baseline IGF1 levels, with a median z-score of -0.94 (range -1.96 to 1.70). MRI pituitary imaging was performed in 20 patients and showed no significant pituitary pathology. All patients achieved hypoglycemia <=40 mg/dL during the insulin tolerance test. Peak median cortisol level was 11 mcg/dL (range 5.4-17). Nineteen patients (86%) also had partial GH deficiency (defined as a peak GH < 4 ng/mL) with a median GH level of 0.36 ng/mL (range 0.03-3.83). Cosyntropin stimulation test was performed in 13 patients (59%) with a 1 mcg dose in 2 patients and 250 mcg dose in 11 patients. The peak cortisol was >=18 mcg/dL in 10 (77%) patients. All patients were started on physiologic glucocorticoid replacement, and 12 patients were started on GH replacement. Endocrinology follow-up information was available for 13 patients, and 8 (62%) reported symptom improvement after starting treatment. Conclusions: Patients with fibromyalgia can have co-existing partial secondary AI and GH deficiency as defined by insulin-induced hypoglycemia. Cosyntropin stimulation test can be used in patients with fibromyalgia, but a normal test does not rule out partial secondary AI. Replacing the underlying deficiency improved symptoms in some patients demonstrating certain fibromyalgia symptoms may overlap with AI and GH deficiency. 1Gur et al. Ann Rheum Dis. 2004. 63(11):1504-1506. 2Kirnap et al. Clin Endocrinol (Oxf). 2001. 55(4):455-459.

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