Accuracy and Limitations of the Growth Hormone (GH) Releasing Hormone-Arginine Retesting in Young Adults With Childhood-Onset GH Deficiency

Giuseppa Patti, Serena Noli, Donatella Capalbo, Anna Maria Elsa Allegri, Flavia Napoli, Marco Cappa, Grazia Maria Ubertini, Annalisa Gallizia, Sara Notarnicola, Anastasia Ibba, Marco Crocco, Stefano Parodi, Mariacarolina Salerno, Sandro Loche, Maria Luisa Garré, Elena Tornari, Mohamad Maghnie, Natascia Di Iorgi

Research output: Contribution to journalArticle

Abstract

Background: Re-testing for GH secretion is needed to confirm the diagnosis of GH deficiency (GHD) after adult height achievement in childhood-onset GHD (COGHD). Aim: To define the cut-off of GH peak after retesting with GH-releasing hormone plus arginine (GHRHarg) in the diagnosis of permanent GHD in COGHD of different etiology. Patients and methods: Eighty-eight COGHD (median age 17.2 y), 29 idiopathic GHD (IGHD), 44 cancer survivors (TGHD) and 15 congenital GHD (CGHD) were enrolled in the study; 54 had isolated GHD (iGHD) and 34 had multiple pituitary hormone deficiencies (MPHD). All were tested with insulin tolerance test (ITT) and GHRHarg. IGHD with a GH response to ITT ≥6μg/L were considered true negatives and served as the control group, and patients with a GH response <6μg/L as true positives. Baseline IGF-I was also measured. The diagnostic accuracy of GHRHarg testing and of IGF-I SDS in patients with GHD of different etiologies was evaluated by ROC analysis. Results: Forty-six subjects with a GH peak to ITT ≥6μg/L and 42 with GH peak <6 μg/L showed a GH peak after GHRHarg between 8.8-124μg/L and 0.3-26.3μg/L, respectively; 29 IGHD were true negatives, 42 were true positives and 17 with a high likelihood GHD showed a GH peak to ITT ≥6μg/L. ROC analysis based on the etiology indicated the best diagnostic accuracy for peak GH cutoffs after GHRHarg of 25.3 μg/L in CGHD, 15.7 in TGHD, and 13.8 in MPHD, and for IGF-1 SDS at -2.1 in CGHD, -1.5 in TGHD, and -1.9 in MPHD. Conclusions: Our findings indicate that the best cut-off for GH peak after retesting with GHRHarg changes according to the etiology of GHD during the transition age. Based on these results the diagnostic accuracy of GHRHarg remains questionable.

Original languageEnglish
Pages (from-to)525
JournalFrontiers in Endocrinology
Volume10
DOIs
Publication statusPublished - 2019

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Growth Hormone-Releasing Hormone
Growth Hormone
Arginine
Young Adult
Hormones
Pituitary Hormones
Insulin-Like Growth Factor I
Insulin
ROC Curve
Pituitary Dwarfism
Survivors

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Accuracy and Limitations of the Growth Hormone (GH) Releasing Hormone-Arginine Retesting in Young Adults With Childhood-Onset GH Deficiency. / Patti, Giuseppa; Noli, Serena; Capalbo, Donatella; Allegri, Anna Maria Elsa; Napoli, Flavia; Cappa, Marco; Ubertini, Grazia Maria; Gallizia, Annalisa; Notarnicola, Sara; Ibba, Anastasia; Crocco, Marco; Parodi, Stefano; Salerno, Mariacarolina; Loche, Sandro; Garré, Maria Luisa; Tornari, Elena; Maghnie, Mohamad; Di Iorgi, Natascia.

In: Frontiers in Endocrinology, Vol. 10, 2019, p. 525.

Research output: Contribution to journalArticle

Patti, Giuseppa ; Noli, Serena ; Capalbo, Donatella ; Allegri, Anna Maria Elsa ; Napoli, Flavia ; Cappa, Marco ; Ubertini, Grazia Maria ; Gallizia, Annalisa ; Notarnicola, Sara ; Ibba, Anastasia ; Crocco, Marco ; Parodi, Stefano ; Salerno, Mariacarolina ; Loche, Sandro ; Garré, Maria Luisa ; Tornari, Elena ; Maghnie, Mohamad ; Di Iorgi, Natascia. / Accuracy and Limitations of the Growth Hormone (GH) Releasing Hormone-Arginine Retesting in Young Adults With Childhood-Onset GH Deficiency. In: Frontiers in Endocrinology. 2019 ; Vol. 10. pp. 525.
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title = "Accuracy and Limitations of the Growth Hormone (GH) Releasing Hormone-Arginine Retesting in Young Adults With Childhood-Onset GH Deficiency",
abstract = "Background: Re-testing for GH secretion is needed to confirm the diagnosis of GH deficiency (GHD) after adult height achievement in childhood-onset GHD (COGHD). Aim: To define the cut-off of GH peak after retesting with GH-releasing hormone plus arginine (GHRHarg) in the diagnosis of permanent GHD in COGHD of different etiology. Patients and methods: Eighty-eight COGHD (median age 17.2 y), 29 idiopathic GHD (IGHD), 44 cancer survivors (TGHD) and 15 congenital GHD (CGHD) were enrolled in the study; 54 had isolated GHD (iGHD) and 34 had multiple pituitary hormone deficiencies (MPHD). All were tested with insulin tolerance test (ITT) and GHRHarg. IGHD with a GH response to ITT ≥6μg/L were considered true negatives and served as the control group, and patients with a GH response <6μg/L as true positives. Baseline IGF-I was also measured. The diagnostic accuracy of GHRHarg testing and of IGF-I SDS in patients with GHD of different etiologies was evaluated by ROC analysis. Results: Forty-six subjects with a GH peak to ITT ≥6μg/L and 42 with GH peak <6 μg/L showed a GH peak after GHRHarg between 8.8-124μg/L and 0.3-26.3μg/L, respectively; 29 IGHD were true negatives, 42 were true positives and 17 with a high likelihood GHD showed a GH peak to ITT ≥6μg/L. ROC analysis based on the etiology indicated the best diagnostic accuracy for peak GH cutoffs after GHRHarg of 25.3 μg/L in CGHD, 15.7 in TGHD, and 13.8 in MPHD, and for IGF-1 SDS at -2.1 in CGHD, -1.5 in TGHD, and -1.9 in MPHD. Conclusions: Our findings indicate that the best cut-off for GH peak after retesting with GHRHarg changes according to the etiology of GHD during the transition age. Based on these results the diagnostic accuracy of GHRHarg remains questionable.",
author = "Giuseppa Patti and Serena Noli and Donatella Capalbo and Allegri, {Anna Maria Elsa} and Flavia Napoli and Marco Cappa and Ubertini, {Grazia Maria} and Annalisa Gallizia and Sara Notarnicola and Anastasia Ibba and Marco Crocco and Stefano Parodi and Mariacarolina Salerno and Sandro Loche and Garr{\'e}, {Maria Luisa} and Elena Tornari and Mohamad Maghnie and {Di Iorgi}, Natascia",
year = "2019",
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volume = "10",
pages = "525",
journal = "Frontiers in Endocrinology",
issn = "1664-2392",
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TY - JOUR

T1 - Accuracy and Limitations of the Growth Hormone (GH) Releasing Hormone-Arginine Retesting in Young Adults With Childhood-Onset GH Deficiency

AU - Patti, Giuseppa

AU - Noli, Serena

AU - Capalbo, Donatella

AU - Allegri, Anna Maria Elsa

AU - Napoli, Flavia

AU - Cappa, Marco

AU - Ubertini, Grazia Maria

AU - Gallizia, Annalisa

AU - Notarnicola, Sara

AU - Ibba, Anastasia

AU - Crocco, Marco

AU - Parodi, Stefano

AU - Salerno, Mariacarolina

AU - Loche, Sandro

AU - Garré, Maria Luisa

AU - Tornari, Elena

AU - Maghnie, Mohamad

AU - Di Iorgi, Natascia

PY - 2019

Y1 - 2019

N2 - Background: Re-testing for GH secretion is needed to confirm the diagnosis of GH deficiency (GHD) after adult height achievement in childhood-onset GHD (COGHD). Aim: To define the cut-off of GH peak after retesting with GH-releasing hormone plus arginine (GHRHarg) in the diagnosis of permanent GHD in COGHD of different etiology. Patients and methods: Eighty-eight COGHD (median age 17.2 y), 29 idiopathic GHD (IGHD), 44 cancer survivors (TGHD) and 15 congenital GHD (CGHD) were enrolled in the study; 54 had isolated GHD (iGHD) and 34 had multiple pituitary hormone deficiencies (MPHD). All were tested with insulin tolerance test (ITT) and GHRHarg. IGHD with a GH response to ITT ≥6μg/L were considered true negatives and served as the control group, and patients with a GH response <6μg/L as true positives. Baseline IGF-I was also measured. The diagnostic accuracy of GHRHarg testing and of IGF-I SDS in patients with GHD of different etiologies was evaluated by ROC analysis. Results: Forty-six subjects with a GH peak to ITT ≥6μg/L and 42 with GH peak <6 μg/L showed a GH peak after GHRHarg between 8.8-124μg/L and 0.3-26.3μg/L, respectively; 29 IGHD were true negatives, 42 were true positives and 17 with a high likelihood GHD showed a GH peak to ITT ≥6μg/L. ROC analysis based on the etiology indicated the best diagnostic accuracy for peak GH cutoffs after GHRHarg of 25.3 μg/L in CGHD, 15.7 in TGHD, and 13.8 in MPHD, and for IGF-1 SDS at -2.1 in CGHD, -1.5 in TGHD, and -1.9 in MPHD. Conclusions: Our findings indicate that the best cut-off for GH peak after retesting with GHRHarg changes according to the etiology of GHD during the transition age. Based on these results the diagnostic accuracy of GHRHarg remains questionable.

AB - Background: Re-testing for GH secretion is needed to confirm the diagnosis of GH deficiency (GHD) after adult height achievement in childhood-onset GHD (COGHD). Aim: To define the cut-off of GH peak after retesting with GH-releasing hormone plus arginine (GHRHarg) in the diagnosis of permanent GHD in COGHD of different etiology. Patients and methods: Eighty-eight COGHD (median age 17.2 y), 29 idiopathic GHD (IGHD), 44 cancer survivors (TGHD) and 15 congenital GHD (CGHD) were enrolled in the study; 54 had isolated GHD (iGHD) and 34 had multiple pituitary hormone deficiencies (MPHD). All were tested with insulin tolerance test (ITT) and GHRHarg. IGHD with a GH response to ITT ≥6μg/L were considered true negatives and served as the control group, and patients with a GH response <6μg/L as true positives. Baseline IGF-I was also measured. The diagnostic accuracy of GHRHarg testing and of IGF-I SDS in patients with GHD of different etiologies was evaluated by ROC analysis. Results: Forty-six subjects with a GH peak to ITT ≥6μg/L and 42 with GH peak <6 μg/L showed a GH peak after GHRHarg between 8.8-124μg/L and 0.3-26.3μg/L, respectively; 29 IGHD were true negatives, 42 were true positives and 17 with a high likelihood GHD showed a GH peak to ITT ≥6μg/L. ROC analysis based on the etiology indicated the best diagnostic accuracy for peak GH cutoffs after GHRHarg of 25.3 μg/L in CGHD, 15.7 in TGHD, and 13.8 in MPHD, and for IGF-1 SDS at -2.1 in CGHD, -1.5 in TGHD, and -1.9 in MPHD. Conclusions: Our findings indicate that the best cut-off for GH peak after retesting with GHRHarg changes according to the etiology of GHD during the transition age. Based on these results the diagnostic accuracy of GHRHarg remains questionable.

U2 - 10.3389/fendo.2019.00525

DO - 10.3389/fendo.2019.00525

M3 - Article

C2 - 31417499

VL - 10

SP - 525

JO - Frontiers in Endocrinology

JF - Frontiers in Endocrinology

SN - 1664-2392

ER -