GROWTH HORMONE ESTIMATION;

Introduction: Despite the use of growth hormone replacement therapy for decades, our ability to make a definitive diagnosisof growth hormone deficiency in children is limited. Growth hormone stimulation tests have been used to discriminate between Growthhormone deficiency and idiopathic short stature. However all these tests lack reproducibility, accuracy, cost affectivity and safety. Insulinlikegrowth factor-1 is an effector hormone and its serum level may be used as simple, easy to perform diagnostic test for growthhormone deficiency. Objective: To determine the efficacy of IGF-1 as a diagnostic tool in children with growth hormone deficiency. StudyDesign: Prospective cross sectional survey. Place of Study: Departments of Pediatrics and Pathology, Shalamar Medical & DentalCollege, Lahore. Duration of study: 1st July to 31st December, 2011. Material & Methods: We included 40 children of 3.5 – 17 year ageand detailed clinical data was collected. All these children were subjected to stimulation by standardized exercise on treadmill, after takingbasal blood samples for GH and IGF-1. Post stimulation growth hormone was recorded to identify growth hormone deficient children.Results: 17 (42.5%) children had post stimulation growth hormone level <10ng/ml while 23 (57.5%) had values >10ng/ml. Postexercise stimulation GH level showed weak correlation with IGF-1 in either of the two study groups. P value was found >0.05 in deficientas well as sufficient groups, depicting non significance of IGF-1 in relation to post stimulation GH level. Conclusions: IGF-1 is not asuitable surrogate diagnostic marker for growth hormone deficiency. Diagnosis should always be based on combination of auxologicalbiochemical, radiological and genetic considerations, Abbreviations: GHD – Growth Hormone Deficiency, GH – Growth Hormone,GHSTs – Growth Hormone Stimulation Tests, IGF-1 – Insulin-like Growth Factor-1, MPH – Mid Parental Height, BA – Bone Age.

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Impact of IGF-1 Normative Datasets on Indication and Outcome of Growth Hormone Stimulation Testing

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1383 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A678-A679

Author(s):

Prim de Bie ◽

Annemieke C Heijboer ◽

Martine M L Deckers

Keyword(s):

Growth Hormone ◽

Growth Hormone Deficiency ◽

Stimulation Test ◽

Hormone Deficiency ◽

Growth Disorders ◽

Z Score ◽

Hormone Stimulation ◽

Stimulation Tests ◽

Z Scores ◽

The Impact

Abstract In the Netherlands, the diagnosis of growth hormone deficiency in children follows the Dutch national guidelines for Triage and Diagnosis of Growth Disorders in Children. Initial biochemical evaluation includes an IGF-1 measurement as screening parameter for growth hormone deficiency. Based on the clinical probability of growth hormone deficiency and the IGF-1 Z-score, a growth hormone stimulation test is performed if serum IGF-1 Z-score is < 0 SD in case of a high probability and if serum IGF-1 Z-score is < -1 SD in case of low probability. An IGF-1 Z-score > 0 SD virtually excludes a growth hormone deficiency disorder. The interpretation of growth hormone stimulation testing is dependent on both the peak growth hormone concentration, but also on the baseline IGF-1 Z-score, particularly in cases of partial deficiency. Although, nation wide, Dutch laboratories have harmonized their measurement for IGF-1 (as was previously done for growth hormone), a Dutch harmonized normative data set has not been widely adopted. Moreover a clinical evaluation of the implementation of this dataset based on dynamic testing has not been published. To assess the impact of choice of a particular normative dataset on the diagnosis of growth hormone deficiency we recalculated Z-scores of IGF-1 measurements between 2016 and 2019, using our home reference values based on de normative dataset by Elmlinger (E)1, and using the normative datasets defined by Bidlingmaier (B)2 and by the Dutch IGF-1 harmonization program (NL). Based on these three Z-scores, the outcomes of growth hormone stimulation tests performed in this period (n=86) were reassessed according to the interpretation described in the Dutch guideline. Using all three normative datasets the same 4 patients were identified as likely to have a growth hormone deficiency, whereas 10(E), 10(B), or 8(NL) patients were identified as possible partial growth hormone deficiency. In 70(E), 66(B) or 72(NL) patients the growth hormone stimulation test was unaffected. Using normative dataset B, 6 patients displayed a pattern associated with a possible growth hormone resistance, or of bio-inactive growth hormone syndromes, which based on its incidence would be unlikely for a secondary care setting. A striking observation was however, that of all patients with a normal stimulation test 9 (E)/16 (B) or 30 (NL) had a IGF-1 Z-score of > 0 SD. This implies that, for the diagnosis of growth hormone deficiency, it is safe to implement the Dutch harmonized dataset, which in addition could result in a reduction in the number of growth hormone stimulation tests that have to be performed. References: 1. Elmlinger MW et al. Clin Chem Lab Med. 2004;42(6):654-64. 2. Bidlingmaier M et al. J Clin Endocrinol Metab. 2014 May;99(5):1712-21.

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New Insights in Growth Hormone Stimulation Tests Protocols

Acta Medica Marisiensis ◽

10.2478/amma-2018-0021 ◽

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.

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O Papel dos Testes de Estimulação Farmacológica no Diagnóstico da Deficiência de Hormona do Crescimento em Crianças e Adolescentes

Acta Médica Portuguesa ◽

10.20344/amp.4878 ◽

2014 ◽

Vol 27 (5) ◽

pp. 587

Author(s):

Jean-Pierre Gonçalves ◽

Filipa Correia ◽

Helena Cardoso ◽

Teresa Borges ◽

Maria João Oliveira

Keyword(s):

Growth Hormone ◽

Logistic Regression ◽

Growth Hormone Deficiency ◽

Hormone Deficiency ◽

Growth Disorders ◽

Z Score ◽

Hormone Stimulation ◽

Growth Hormone Peak ◽

Pharmacological Stimulation ◽

Stimulation Tests

Introduction: The incidence of short stature associated with growth hormone deficiency has been estimated to be about 1:4000 to 1:10000. It is the main indication for treatment with recombinant growth hormone. Objectives: The aims of the study were to evaluate the results of growth hormone stimulation tests and identify the growth hormone deficiency predictors. Material and Methods: A cross-sectional, analytical and observational study was conducted. We studied all the children and adolescents submitted to growth hormone pharmacological stimulation tests between January 2008 and May 2012. Growth hormone deficiency diagnosis was confirmed by two negatives growth hormone stimulation tests (growth hormone peak < 7 ng/ml). The statistical analysis was performed using student t-test, chi-square, Pearson correlation and logistic regression. Statistical significance determined at the 5% level (p ≤ 0.05). Results: Pharmacological stimulation tests were performed in 89 patients, with a median age of 10 [3-17] years. Clonidine (n = 85) and insulin tolerance test (n = 4) were the first growth hormone stimulation tests performed. Growth hormone deficiency was confirmed in 22 cases. In cases with two growth hormone stimulation tests, the growth hormone peak showed a moderate correlation (r = 0.593, p = 0.01). In logistic regression model height (z-score) and the growth hormone peak in first stimulation test were predictors of growth hormone deficiency diagnosis (each one unit increase in z-score decrease the growth hormone deficiency probability). Discussion: Measurement of IGF-1 cannot be used in diagnosing growth hormone deficiency. Conclusion: Auxological criteria associated with a positive test seems to be a reliable diagnostic tool for growth hormone deficiency. Keywords: Growth Disorders; Human Growth Hormone/blood.

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Clinical and auxological characteristics of growth hormone deficiency in children of the southern region of Ukraine

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(1)-07 ◽

2021 ◽

Vol 25 (1) ◽

pp. 40-44

Author(s):

L. I. Senkivska ◽

M. L. Aryayev

Keyword(s):

Growth Hormone ◽

Growth Hormone Deficiency ◽

Gh Deficiency ◽

Bone Age ◽

Hormone Deficiency ◽

P Value ◽

Organic Basis ◽

Pituitary Hormone ◽

Realistic Assessment ◽

Stimulation Tests

Anotation. Regional clinical and auxological studies of growth hormone deficiency (GHD) in children contribute to a realistic assessment of the severity of the problem and prevent underdiagnostics of the disease. The aim of the study is to analyze the features of various forms of GHD in children of the Odessa region on the basis of the clinicians’ integrated assessment of history, physical examination, auxology, stature, growth velocity, bone age (BA), 2 growth hormone (GH) stimulation tests, insulin-like growth factor, magnetic resonance imaging in 92 children with GHD in the Odessa region. Parametric variables were assessed using criteria t-test and хі-square (χ2). The p value <0,05 was considered statistically significant. Decrease in SDS height from - 2,1 tо - 6,6 was found. Isolated GHD (IGHD) was diagnosed in 65,2% of diseases, multiple pituitary hormone deficiency (MPHD) in 34,8% cases. IGHD was more often idiopathic and MPHD was more often arose on an organic basis. Chronological age (CA), BA and height of children with MPHD were lower at the start of therapy compared with IGHD. Complete GH deficiency was more common in children with MPHD (62,7%), while partial GH deficiency was more common in children with IGHD (81,7%). Very low values of the coefficient CA/BA (less than 0,55) were significantly more often detected in children with MPHD compared with IGHD. The regional clinical and auxological characteristics of GHD in children in the Odessa region can be considered in further study of population aspects and patterns of growth.

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Diagnosis of Growth Hormone Deficiency and Growth Hormone Stimulation Tests

Diagnostics of Endocrine Function in Children and Adolescents ◽

10.1159/000073547 ◽

2003 ◽

pp. 107-128 ◽

Cited By ~ 12

Author(s):

M.B. Ranke

Keyword(s):

Growth Hormone ◽

Growth Hormone Deficiency ◽

Hormone Deficiency ◽

Hormone Stimulation ◽

Stimulation Tests

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When is a positive test for pediatric growth hormone deficiency a true positive test?

Hormone Research in Paediatrics ◽

10.1159/000521281 ◽

2021 ◽

Author(s):

George M Bright ◽

Peter A Morris ◽

Ron G Rosenfeld

Keyword(s):

Growth Hormone ◽

Diagnostic Accuracy ◽

Growth Hormone Deficiency ◽

Positive Test ◽

Hormone Deficiency ◽

True Positive ◽

Hormone Stimulation ◽

Positive Growth ◽

Stimulation Tests ◽

Low Prevalence

Given the low prevalence rate of growth hormone deficiency (GHD) and the high false positive rates for growth hormone stimulation tests, the probability of GHD in a child with short stature and positive growth hormone stimulation tests is 0.028 (about 1 in 36). Without further information, most positive growth hormone stimulation tests will be false positives. Further study may yield the necessary improvements in the diagnostic accuracy for GHD in children.

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