Reevaluation of growth hormone (GH) secretion in 69 adults diagnosed as GH-deficient patients during childhood

Salvatore Longobardi, Bartolomeo Merola, Rosario Pivonello, Francesca Di Rella, Carolina Di Somma, Annamaria Colao, Ezio Ghigo, Franco Camanni, Gaetano Lombardi

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Abstract

At present, the most appropriate method for diagnosing GH deficiency (GHD) in adults remains unclear. Recently, it has been demonstrated that GHD in adults can be identified by insulin tolerance test (ITT). Moreover, it has been described that the GHRH plus pyridostigmine (GHRH+PD) test is more accurate than an arginine, glucagon, levodopa, or GHRH test to diagnose GHD in adults. In the current study, firstly we reevaluated GH secretion by the GHRH+PD test in adults previously diagnosed as GH deficient in childhood. The study included 69 patients and 38 healthy subjects. After the GHRH+PD test, the patients and the healthy subjects had peak GH levels of 10.6 ± 11.2 and 56.7 ± 28.1 μg/L, respectively (P <0.001). The patients were divided into two groups, responder patients and nonresponder patients, considering an arbitrary cut-off of 10 μg/L as the GH peak after the GHRH+PD test. Thirty- nine patients had GH peak below 10 μg/L (1.9 ± 1.7 μg/L), whereas the remaining 30 patients above 10 μg/L (21.6 ± 8.1 μg/L; P <0.001). Secondly, we compared the GHRH+PD test and the ITT in diagnosing GHD. Twenty- one of the 39 patients with a GH peak below 10 μg/L and 29 of the 30 patients with a GH peak above 10 μg/L after the GHRH+PD test underwent an ITT. The GH peak after insulin administration was 2.1 ± 1.7 μg/L in nonresponder patients and 21.1 ± 9.3 μg/L in responder patients after the GHRH+PD test (P <0.001). Three of the responder patients to the GHRH+PD test were identified as GH deficient by the ITT. The relative diagnostic accuracies of the two tests to discriminate GH-deficient patients from healthy subjects were similar (ITT vs. GHRH test: sensitivity, 100%, specificity, 90%; GHRH+PD vs. ITT: sensitivity, 88%; specificity, 100%). In conclusion, in adults previously diagnosed as GH deficient, it is mandatory to reevaluate GH secretion. GHRH+PD and/or ITT are able to diagnose GHD in adults with similar accuracies. Taking into account the potential side- effects of the ITT, however, the GHRH+PD test is the most reliable and safe test to accurately diagnose GHD status in adults.

Original languageEnglish
Pages (from-to)1244-1247
Number of pages4
JournalJournal of Clinical Endocrinology and Metabolism
Volume81
Issue number3
DOIs
Publication statusPublished - 1996

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Growth Hormone
Insulin
Healthy Volunteers
Pyridostigmine Bromide
Levodopa
Glucagon
Arginine
Sensitivity and Specificity

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Reevaluation of growth hormone (GH) secretion in 69 adults diagnosed as GH-deficient patients during childhood. / Longobardi, Salvatore; Merola, Bartolomeo; Pivonello, Rosario; Di Rella, Francesca; Di Somma, Carolina; Colao, Annamaria; Ghigo, Ezio; Camanni, Franco; Lombardi, Gaetano.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 81, No. 3, 1996, p. 1244-1247.

Research output: Contribution to journalArticle

Longobardi, S, Merola, B, Pivonello, R, Di Rella, F, Di Somma, C, Colao, A, Ghigo, E, Camanni, F & Lombardi, G 1996, 'Reevaluation of growth hormone (GH) secretion in 69 adults diagnosed as GH-deficient patients during childhood', Journal of Clinical Endocrinology and Metabolism, vol. 81, no. 3, pp. 1244-1247. https://doi.org/10.1210/jc.81.3.1244
Longobardi, Salvatore ; Merola, Bartolomeo ; Pivonello, Rosario ; Di Rella, Francesca ; Di Somma, Carolina ; Colao, Annamaria ; Ghigo, Ezio ; Camanni, Franco ; Lombardi, Gaetano. / Reevaluation of growth hormone (GH) secretion in 69 adults diagnosed as GH-deficient patients during childhood. In: Journal of Clinical Endocrinology and Metabolism. 1996 ; Vol. 81, No. 3. pp. 1244-1247.
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abstract = "At present, the most appropriate method for diagnosing GH deficiency (GHD) in adults remains unclear. Recently, it has been demonstrated that GHD in adults can be identified by insulin tolerance test (ITT). Moreover, it has been described that the GHRH plus pyridostigmine (GHRH+PD) test is more accurate than an arginine, glucagon, levodopa, or GHRH test to diagnose GHD in adults. In the current study, firstly we reevaluated GH secretion by the GHRH+PD test in adults previously diagnosed as GH deficient in childhood. The study included 69 patients and 38 healthy subjects. After the GHRH+PD test, the patients and the healthy subjects had peak GH levels of 10.6 ± 11.2 and 56.7 ± 28.1 μg/L, respectively (P <0.001). The patients were divided into two groups, responder patients and nonresponder patients, considering an arbitrary cut-off of 10 μg/L as the GH peak after the GHRH+PD test. Thirty- nine patients had GH peak below 10 μg/L (1.9 ± 1.7 μg/L), whereas the remaining 30 patients above 10 μg/L (21.6 ± 8.1 μg/L; P <0.001). Secondly, we compared the GHRH+PD test and the ITT in diagnosing GHD. Twenty- one of the 39 patients with a GH peak below 10 μg/L and 29 of the 30 patients with a GH peak above 10 μg/L after the GHRH+PD test underwent an ITT. The GH peak after insulin administration was 2.1 ± 1.7 μg/L in nonresponder patients and 21.1 ± 9.3 μg/L in responder patients after the GHRH+PD test (P <0.001). Three of the responder patients to the GHRH+PD test were identified as GH deficient by the ITT. The relative diagnostic accuracies of the two tests to discriminate GH-deficient patients from healthy subjects were similar (ITT vs. GHRH test: sensitivity, 100{\%}, specificity, 90{\%}; GHRH+PD vs. ITT: sensitivity, 88{\%}; specificity, 100{\%}). In conclusion, in adults previously diagnosed as GH deficient, it is mandatory to reevaluate GH secretion. GHRH+PD and/or ITT are able to diagnose GHD in adults with similar accuracies. Taking into account the potential side- effects of the ITT, however, the GHRH+PD test is the most reliable and safe test to accurately diagnose GHD status in adults.",
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AU - Di Somma, Carolina

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AU - Ghigo, Ezio

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AU - Lombardi, Gaetano

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