Reliability of clonidine testing for the diagnosis of growth hormone deficiency in children and adolescents

Anastasia Ibba, Chiara Guzzetti, Letizia Casula, Mariacarolina Salerno, Natascia Di Iorgi, Anna Maria Elsa Allegri, Marco Cappa, Mohamad Maghnie, Sandro Loche

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Abstract

OBJECTIVE: The diagnosis of growth hormone deficiency (GHD) is currently based on clinical, auxological, biochemical and neuro-radiological investigation. Provocative tests of GH secretion using physiological/pharmacological stimuli are required to confirm GHD. The clonidine test (CT) is widely used to assess GH secretory status. In this retrospective study, we analyzed the reliability of CT and the effect of puberty in a large number of children with short stature who had been evaluated for suspected GHD.

DESIGN AND PATIENTS: Data were collected retrospectively from 327 children and adolescents with short stature (204 boys and 123 girls, median age 10.5 years (IQR 7.90-12.40) followed in four Italian Paediatric Endocrine Units (Cagliari, Genova, Napoli and Roma) between 2005 and 2013.

MEASUREMENTS: All children underwent CT as the first GH stimulation test after exclusion of other known cause of their short stature.

RESULTS: In 73 prepubertal children and 25 pubertal children, the GH peak after CT was <7 μg/L. GHD was confirmed in 87 (37 organic, 50 idiopathic). Six prepubertal and five pubertal patients showed false positive responses. The median BMI-SDS in these children was similar to that of children with GH peak ≥7 μg/L, and none were obese. Overall, the prevalence of false-positive responses was 3.3%. The median (IQR) peak GH after CT was similar between prepubertal and pubertal GHD (3.80 μg/L [1.7-6.00] vs 3.51 μg/L [0.76-5.74]) and non-GHD (13.70 μg/L [10.70-18.40] vs 12.40 μg/L [9.90-19.25]) children.

CONCLUSIONS: Our results show that CT is a reliable and safe GH-releasing agent in both prepubertal and pubertal children.

Original languageEnglish
JournalClinical Endocrinology
DOIs
Publication statusE-pub ahead of print - Sep 1 2018

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Clonidine
Growth Hormone
Roma
Puberty
Retrospective Studies
Hormones
Pharmacology
Pediatrics

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Reliability of clonidine testing for the diagnosis of growth hormone deficiency in children and adolescents. / Ibba, Anastasia; Guzzetti, Chiara; Casula, Letizia; Salerno, Mariacarolina; Di Iorgi, Natascia; Allegri, Anna Maria Elsa; Cappa, Marco; Maghnie, Mohamad; Loche, Sandro.

In: Clinical Endocrinology, 01.09.2018.

Research output: Contribution to journalArticle

Ibba, Anastasia ; Guzzetti, Chiara ; Casula, Letizia ; Salerno, Mariacarolina ; Di Iorgi, Natascia ; Allegri, Anna Maria Elsa ; Cappa, Marco ; Maghnie, Mohamad ; Loche, Sandro. / Reliability of clonidine testing for the diagnosis of growth hormone deficiency in children and adolescents. In: Clinical Endocrinology. 2018.
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title = "Reliability of clonidine testing for the diagnosis of growth hormone deficiency in children and adolescents",
abstract = "OBJECTIVE: The diagnosis of growth hormone deficiency (GHD) is currently based on clinical, auxological, biochemical and neuro-radiological investigation. Provocative tests of GH secretion using physiological/pharmacological stimuli are required to confirm GHD. The clonidine test (CT) is widely used to assess GH secretory status. In this retrospective study, we analyzed the reliability of CT and the effect of puberty in a large number of children with short stature who had been evaluated for suspected GHD.DESIGN AND PATIENTS: Data were collected retrospectively from 327 children and adolescents with short stature (204 boys and 123 girls, median age 10.5 years (IQR 7.90-12.40) followed in four Italian Paediatric Endocrine Units (Cagliari, Genova, Napoli and Roma) between 2005 and 2013.MEASUREMENTS: All children underwent CT as the first GH stimulation test after exclusion of other known cause of their short stature.RESULTS: In 73 prepubertal children and 25 pubertal children, the GH peak after CT was <7 μg/L. GHD was confirmed in 87 (37 organic, 50 idiopathic). Six prepubertal and five pubertal patients showed false positive responses. The median BMI-SDS in these children was similar to that of children with GH peak ≥7 μg/L, and none were obese. Overall, the prevalence of false-positive responses was 3.3{\%}. The median (IQR) peak GH after CT was similar between prepubertal and pubertal GHD (3.80 μg/L [1.7-6.00] vs 3.51 μg/L [0.76-5.74]) and non-GHD (13.70 μg/L [10.70-18.40] vs 12.40 μg/L [9.90-19.25]) children.CONCLUSIONS: Our results show that CT is a reliable and safe GH-releasing agent in both prepubertal and pubertal children.",
author = "Anastasia Ibba and Chiara Guzzetti and Letizia Casula and Mariacarolina Salerno and {Di Iorgi}, Natascia and Allegri, {Anna Maria Elsa} and Marco Cappa and Mohamad Maghnie and Sandro Loche",
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TY - JOUR

T1 - Reliability of clonidine testing for the diagnosis of growth hormone deficiency in children and adolescents

AU - Ibba, Anastasia

AU - Guzzetti, Chiara

AU - Casula, Letizia

AU - Salerno, Mariacarolina

AU - Di Iorgi, Natascia

AU - Allegri, Anna Maria Elsa

AU - Cappa, Marco

AU - Maghnie, Mohamad

AU - Loche, Sandro

N1 - © 2018 John Wiley & Sons Ltd.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - OBJECTIVE: The diagnosis of growth hormone deficiency (GHD) is currently based on clinical, auxological, biochemical and neuro-radiological investigation. Provocative tests of GH secretion using physiological/pharmacological stimuli are required to confirm GHD. The clonidine test (CT) is widely used to assess GH secretory status. In this retrospective study, we analyzed the reliability of CT and the effect of puberty in a large number of children with short stature who had been evaluated for suspected GHD.DESIGN AND PATIENTS: Data were collected retrospectively from 327 children and adolescents with short stature (204 boys and 123 girls, median age 10.5 years (IQR 7.90-12.40) followed in four Italian Paediatric Endocrine Units (Cagliari, Genova, Napoli and Roma) between 2005 and 2013.MEASUREMENTS: All children underwent CT as the first GH stimulation test after exclusion of other known cause of their short stature.RESULTS: In 73 prepubertal children and 25 pubertal children, the GH peak after CT was <7 μg/L. GHD was confirmed in 87 (37 organic, 50 idiopathic). Six prepubertal and five pubertal patients showed false positive responses. The median BMI-SDS in these children was similar to that of children with GH peak ≥7 μg/L, and none were obese. Overall, the prevalence of false-positive responses was 3.3%. The median (IQR) peak GH after CT was similar between prepubertal and pubertal GHD (3.80 μg/L [1.7-6.00] vs 3.51 μg/L [0.76-5.74]) and non-GHD (13.70 μg/L [10.70-18.40] vs 12.40 μg/L [9.90-19.25]) children.CONCLUSIONS: Our results show that CT is a reliable and safe GH-releasing agent in both prepubertal and pubertal children.

AB - OBJECTIVE: The diagnosis of growth hormone deficiency (GHD) is currently based on clinical, auxological, biochemical and neuro-radiological investigation. Provocative tests of GH secretion using physiological/pharmacological stimuli are required to confirm GHD. The clonidine test (CT) is widely used to assess GH secretory status. In this retrospective study, we analyzed the reliability of CT and the effect of puberty in a large number of children with short stature who had been evaluated for suspected GHD.DESIGN AND PATIENTS: Data were collected retrospectively from 327 children and adolescents with short stature (204 boys and 123 girls, median age 10.5 years (IQR 7.90-12.40) followed in four Italian Paediatric Endocrine Units (Cagliari, Genova, Napoli and Roma) between 2005 and 2013.MEASUREMENTS: All children underwent CT as the first GH stimulation test after exclusion of other known cause of their short stature.RESULTS: In 73 prepubertal children and 25 pubertal children, the GH peak after CT was <7 μg/L. GHD was confirmed in 87 (37 organic, 50 idiopathic). Six prepubertal and five pubertal patients showed false positive responses. The median BMI-SDS in these children was similar to that of children with GH peak ≥7 μg/L, and none were obese. Overall, the prevalence of false-positive responses was 3.3%. The median (IQR) peak GH after CT was similar between prepubertal and pubertal GHD (3.80 μg/L [1.7-6.00] vs 3.51 μg/L [0.76-5.74]) and non-GHD (13.70 μg/L [10.70-18.40] vs 12.40 μg/L [9.90-19.25]) children.CONCLUSIONS: Our results show that CT is a reliable and safe GH-releasing agent in both prepubertal and pubertal children.

U2 - 10.1111/cen.13845

DO - 10.1111/cen.13845

M3 - Article

C2 - 30171702

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

ER -