scholarly journals Cortisol responses to the insulin tolerance test and glucagon stimulation tests in children with idiopathic short stature and idiopathic isolated growth hormone deficiency

2015 ◽  
Author(s):  
Hussain Alsaffar ◽  
Iyad Ahmed ◽  
Pauline Blundell ◽  
Urmi Das ◽  
Poonam Dharmaraj ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Idiopathic Short Stature ◽  
Hormone Deficiency ◽  
Insulin Tolerance ◽  
Stimulation Tests ◽  
Cortisol Responses

scholarly journals Should Pediatric Endocrinologists Consider More Carefully When to Perform a Stimulation Test?

2021 ◽  
Vol 12 ◽  
Author(s):  
Arturo Penco ◽  
Benedetta Bossini ◽  
Manuela Giangreco ◽  
Viviana Vidonis ◽  
Giada Vittori ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Standard Dose ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Hormone Deficiency ◽  
Pediatric Endocrinology ◽  
Insulin Tolerance ◽  
Stimulation Tests ◽  
Lhrh Test

IntroductionPediatric endocrinology rely greatly on hormone stimulation tests which demand time, money and effort. The knowledge of the pattern of pediatric endocrinology stimulation tests is therefore crucial to optimize resources and guide public health interventions. Aim of the study was to investigate the distribution of endocrine stimulation tests and the prevalence of pathological findings over a year and to explore whether single basal hormone concentrations could have saved unnecessary stimulation tests.MethodsRetrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 in a tertiary center.ResultsOverall, 278 tests were performed on 206 patients. The most performed test was arginine tolerance test (34%), followed by LHRH test (24%) and standard dose Synachthen test (19%), while the higher rate of pathological response was found in insulin tolerance test to detect growth hormone deficiency (81%), LHRH test to detect central precocious puberty (50%) and arginine tolerance test (41%). No cases of non-classical-congenital adrenal hyperplasia were diagnosed. While 29% of growth hormone deficient children who performed an insulin tolerance test had a pathological peak cortisol, none of them had central adrenal insufficiency confirmed at low dose Synacthen test. The use of basal hormone determinations could save up to 88% of standard dose Synachthen tests, 82% of arginine tolerance + GHRH test, 61% of LHRH test, 12% of tests for adrenal secretion.ConclusionThe use of single basal hormone concentrations could spare up to half of the tests, saving from 32,000 to 79,000 euros in 1 year. Apart from basal cortisol level <108 nmol/L to detect adrenal insufficiency and IGF-1 <-1.5 SDS to detect growth hormone deficiency, all the other cut-off for basal hormone determinations were found valid in order to spare unnecessary stimulation tests.

scholarly journals New Insights in Growth Hormone Stimulation Tests Protocols

2018 ◽  
Vol 64 (4) ◽  
pp. 151-156
Author(s):  
Iulia Armean ◽  
Raluca Pop ◽  
Iuliana Gherlan ◽  
Ionela Pașcanu
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
False Positive Rate ◽  
Tolerance Test ◽  
Hormone Deficiency ◽  
Hormone Stimulation ◽  
Stimulation Tests ◽  
Insulin Test ◽  
Microsoft Office

AbstractObjective: The objective of this study was to analyze the performance of 2 stimulation tests used in the diagnosis of growth hormone deficiency.Method: A retrospective study was conducted on a non-random sample of 310 patients, between 2 and 20 years old, who were hospitalized in the Mureș County Hospital’s Endocrinology Department and in the National Institute of Endocrinology C.I. Parhon with short stature between 2009-2015. Inclusion criteria: all subjects who underwent growth hormone stimulation tests in accordance with the national protocol. Microsoft Office Excel was used for data collection and MedCalc v 12.5 was used for statistical analysis.Results: From the total of 310 patients, 102 were diagnosed in Târgu Mureș and 208 in Bucharest. Sex ratio favored boys (boys:girls 1.64:1). In 173 subjects growth hormone deficiency was confirmed. For both tests the percentage of maximum response was the highest for the 60 minutes blood sample regardless if the test were positive or not. Both tests have 100% sensitivity and negative predictive value, with the highest specificity for the 60 minutes clonidine and 30 minutes insulin. The false positive rate was 60% for the insulin test and 27.2% for clonidine for Târgu Mureș sample and 86.9% for the insulin test and 62.5% for clonidine for Bucharest sample. The concordance of the 2 tests was 49.36%.Conclusions: Stimulating growth hormone testing has a number of limitations but is still needed in some auxological circumstances. We recommend performing the clonidine test first to exclude idiopathic short stature and then the insulin tolerance test for the diagnosis of growth hormone deficiency.

scholarly journals GROWTH HORMONE LEVELS AT INDUCED HYPOGLYCEMIA; AN EFFECTIVE WAY OF DIAGNOSING GROWTH HORMONE DEFICIENCY

2021 ◽  
Vol 71 (1) ◽  
pp. 184-89
Author(s):  
Nida Basharat Khan ◽  
Asif Ali Memon ◽  
Sumbal Nida ◽  
Naveed Asif ◽  
Saima Shakeel Malik ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Plasma Glucose ◽  
Tolerance Test ◽  
Insulin Tolerance Test ◽  
Hormone Deficiency ◽  
Inadequate Response ◽  
Post Induction ◽  
Adequate Response ◽  
Insulin Tolerance

Objective: To introduce a relatively convenient and effective way of conducting Insulin Tolerance Test for diagnosis of Growth Hormone deficiency in children with short stature. Study Design: Cross sectional analytical study. Place and Duration of Study: Conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi, from May 2017 to Jul 2018. Methodology: A total of 185 cases were included. Sample selection was done by non-probability consecutive sampling technique. Insulin tolerance test was performed by taking basal sample for serum growth hormone and plasma glucose levels before giving intravenous insulin bolus according to dose of 0.15 IU/kg. Samples for Growth Hormone level were repeated at time of induced hypoglycemia (defined as plasma glucose level of <2.8 mmol/L), 30 minutes and 60 minutes post induction. Results: Mean age of the patients was 10 ± 4 years, majority 120 (65%) were males. In the study population, 41 (22%) patients showed adequate response to insulin tolerance test while 144 (78%) showed inadequate response. At level of induction, mean growth hormone levels were 31.9 ± 18.8 mIU/l and 4.7 ± 4.4 mIU/l in patients showing adequate and inadequate response respectively (p-value <0.05). Majority 32 (78%) of the patients showing adequate response had peak growth hormone response (>20 mIU/l) at induction alone, followed by 30 minutes post induction; reflecting the significance of these two samples in diagnosis of growth hormone deficiency. Conclusion: We concluded that there is a simpler ...........

Pituitary volume in children with growth hormone deficiency, idiopathic short stature and controls

2016 ◽  
Vol 29 (10) ◽  
Author(s):  
Marion Kessler ◽  
Michael Tenner ◽  
Michael Frey ◽  
Richard Noto
Keyword(s):  
Growth Hormone ◽  
Magnetic Resonance ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Magnetic Resonance Images ◽  
Idiopathic Short Stature ◽  
Hormone Deficiency ◽  
Significant Difference

AbstractBackground:The objective of the study was to describe the pituitary volume (PV) in pediatric patients with isolated growth hormone deficiency (IGHD), idiopathic short stature (ISS) and normal controls.Methods:Sixty-nine patients (57 male, 12 female), with a mean age of 11.9 (±2.0), were determined to have IGHD. ISS was identified in 29 patients (20 male, 9 female), with a mean age of 12.7 (±3.7). Sixty-six controls (28 female, 38 male), mean age 9.8 (±4.7) were also included. Three-dimensional (3D) magnetic resonance images with contrast were obtained to accurately measure PV.Results:There was a significant difference in the mean PV among the three groups. The IGHD patients had a mean PV 230.8 (±89.6), for ISS patients it was 286.8 (±108.2) and for controls it was 343.7 (±145.9) (p<0.001). There was a normal increase in PV with age in the ISS patients and controls, but a minimal increase in the IGHD patients.Conclusions:Those patients with isolated GHD have the greatest reduction in PV compared to controls and the patients with ISS fall in between. We speculate that a possible cause for the slowed growth in some ISS patients might be related to diminished chronic secretion of growth hormone over time, albeit having adequate pituitary reserves to respond acutely to GH stimulation. Thus, what was called neurosecretory GHD in the past, might, in some patients, be relative pituitary hypoplasia and resultant diminished growth hormone secretion. Thus, PV determinations by magnetic resonance imaging (MRI) could assist in the diagnostic evaluation of the slowly growing child.

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