1
|
Yoon JY, Cheon CK, Lee JH, Kwak MJ, Kim HJ, Kim YJ, Lee JE, Chung WY, Kim J, Yoo JH. Response to growth hormone according to provocation test results in idiopathic short stature and idiopathic growth hormone deficiency. Ann Pediatr Endocrinol Metab 2022; 27:37-43. [PMID: 35038835 PMCID: PMC8984754 DOI: 10.6065/apem.2142110.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate growth response in children with either idiopathic short stature (ISS) or growth hormone (GH) deficiency (GHD). METHODS The data of prepubertal GHD or ISS children treated using recombinant human GH were obtained from the LG Growth Study database. GHD children were further divided into partial and complete GHD groups. Growth response and factors predicting growth response after 1 and 2 years of GH treatment were investigated. RESULTS This study included 692 children (98 with ISS, 443 partial GHD, and 151 complete GHD). After 1 year, changes in height standard deviation score (ΔHt-SDS) were 0.78, 0.83, and 0.96 in ISS, partial GHD, and complete GHD, respectively. Height velocity (HV) was 8.72, 9.04, and 9.52 cm/yr in ISS, partial GHD, and complete GHD, respectively. ΔHt-SDS and HV did not differ among the 3 groups. Higher initial body mass index standard deviation score (BMI-SDS) and midparental height standard deviation score (MPH-SDS) were predictors for better growth response after 1 year in ISS and the partial GHD group, respectively. In the complete GHD group, higher Ht-SDS and BMI-SDS predicted better growth response after 1 year. After 2 years of GH treatment, higher BMI-SDS and MPH-SDS predicted a better growth outcome in the partial GHD group, and higher MPH-SDS was a predictor of good growth response in complete GHD. CONCLUSION Clinical characteristics and growth response did not differ among groups. Predictors of growth response differed among the 3 groups, and even in the same group, a higher GH dose would be required when poor response is predicted.
Collapse
Affiliation(s)
- Ju Young Yoon
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea
| | - Chong Kun Cheon
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan, Korea
| | - Jung Hyun Lee
- Department of Pediatrics, Kosin University Gospel Hospital, Busan, Korea
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Busan, Korea
| | - Hyun-Ji Kim
- Department of Pediatrics, Ilsin Christian Hospital, Busan, Korea
| | - Ye Jin Kim
- Department of Pediatrics, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jeong Eun Lee
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | - Woo Yeong Chung
- Department of Pediatrics, Inje University Busan Paik Hospital, Busan, Korea
| | | | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University Hospital, Busan, Korea,Address for correspondence: Jae Ho Yoo Department of Pediatrics, Dong-A University Hospital, Dong-A University College of Medicine, 26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea
| |
Collapse
|
2
|
Ricci Bitti S, Franco M, Albertelli M, Gatto F, Vera L, Ferone D, Boschetti M. GH Replacement in the Elderly: Is It Worth It? Front Endocrinol (Lausanne) 2021; 12:680579. [PMID: 34211437 PMCID: PMC8239420 DOI: 10.3389/fendo.2021.680579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/02/2021] [Indexed: 11/24/2022] Open
Abstract
Growth hormone (GH), once the age of linear growth is completed, continues to play a fundamental role for the human body. In adulthood, GH contributes to regulate muscle, cardiovascular and bone metabolism. The same happens in old age, although there is less data on the effect of GH in the elderly. Regardless the age of onset, a reduced quality of life (QoL), an increased cardiovascular risk and an accelerated age-related decline in physical strength have been demonstrated in the elderly with GH deficiency (EGHD). In adults with GH deficiency (AGHD), recent studies suggest a role of GH replacement therapy (GHrt) in improving lean/fat mass ratio, blood pressure, lipid profile, bone metabolism and QoL. Despite these recent studies, there is still a lack of randomized controlled trials proving these positive effects in EGHD. Moreover, the lack of a long-term positive outcome on mortality, and the cost of GHrt could often impact on treatment decision-making and lead to postpone or avoid the prescription. The aim of this mini-review is to summarize the available data on GHrt in EGHD, in order to highlight its weaknesses and strengths and to provide directions to clinicians that will help in the management of this specific set of patients.
Collapse
Affiliation(s)
- Silvia Ricci Bitti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Marta Franco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
| | - Manuela Albertelli
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Federico Gatto
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Lara Vera
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
| | - Mara Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, Genova, Italy
- Endocrinology Unit, IRCCS Policlinico San Martino, Genova, Italy
- *Correspondence: Mara Boschetti,
| |
Collapse
|
3
|
Nam HK, Kim HR, Lee KH, Rhie YJ. Idiopathic Short Stature Phenotypes among Korean Children: Cluster Analysis. TOHOKU J EXP MED 2019; 248:193-200. [PMID: 31353328 DOI: 10.1620/tjem.248.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Idiopathic short stature (ISS) is a heterogeneous group and their responsiveness to growth hormone treatment varies among individuals. The aim of this study was to identify homogeneous phenotypes to better assess response before the initiation of treatment. We focused on person-centered approaches using a latent profile analysis. Clinical data of 218 children (127 boys and 91 girls) aged 4-15 years were obtained from the "LG Growth Study" which is a non-interventional Korean multicenter registry for growth hormone treatment. Growth hormone dose, first-year difference in height standard deviation score (Δheight SDS), mid-parental height SDS, and initial bone age were inputted into the model. The distribution of scatter plot was clearly distinguished at the chronological age of 8.83 years, Δheight SDS of 0.82 and mean GH dose of 0.36 mg/kg/week. The latent profile analysis revealed three distinct phenotypes names as follows: younger good responder (n = 56), older good responder (n = 111), and older poor responder (n = 51) groups. Despite more than twice the mean growth hormone dose, the older poor responder group showed the least improvement in the mean Δheight SDS. The pretreatment height velocity and peak growth hormone level were lower for the older poor responder group compared with those of the older good responder group. The statistically optimal cutoff point for predicting poor response was 3.41 cm/year for pretreatment height velocity and 9.18 ng/mL for peak growth hormone level. This study offers a new multidimensional approach to enable personalized growth hormone treatment optimization according to ISS phenotypes.
Collapse
Affiliation(s)
- Hyo-Kyoung Nam
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine
| | - Hye Ryun Kim
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine
| | - Kee-Hyoung Lee
- Department of Pediatrics, Korea University Anam Hospital, Korea University College of Medicine
| | - Young-Jun Rhie
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine
| |
Collapse
|
4
|
Wagner CL, Baatz JE, Newton D, Hollis BW. Analytical considerations and general diagnostic and therapeutic ramifications of milk hormones during lactation. Best Pract Res Clin Endocrinol Metab 2018; 32:5-16. [PMID: 29549960 DOI: 10.1016/j.beem.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this review, we will discuss the changes that occur in the mammary gland from pregnancy to lactation and the issues surrounding the analysis of circulating and milk hormones during the stages of lactogenesis. There is a cascade of events that must occur to achieve milk synthesis, milk ejection, and successful transfer to the breastfeeding infant. The adequacy and success of this process is no small measure and the assessment of milk production, the hormones involved in this process and the ability to properly diagnose conditions and causes of low milk supply are critical for the health and well-being of the mother-infant breastfeeding dyad. The normative data that have been amassed in past decades suggest that there are certain values or circulating concentrations of milk hormones, that if lacking or low, could explain low milk supply status. Yet, in looking more closely at the tests themselves, the certainly of what constitutes "normal" can vary depending on the preanalytical conditions that the blood or milk sample were obtained, the methods used in obtaining circulating or milk concentrations, and the standardization of how that result is expressed. The standardization of these aspects of breast milk physiology are essential for providing important normative data to health care professionals and researchers and will result in more consistent findings across multi-disciplinary platforms.
Collapse
Affiliation(s)
- Carol L Wagner
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, United States.
| | - John E Baatz
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, United States.
| | - Danforth Newton
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, United States.
| | - Bruce W Hollis
- Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, United States.
| |
Collapse
|
5
|
Tidblad A, Gustafsson J, Marcus C, Ritzén M, Ekström K. Metabolic differences between short children with GH peak levels in the lower normal range and healthy children of normal height. Growth Horm IGF Res 2017; 34:22-27. [PMID: 28482270 DOI: 10.1016/j.ghir.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/23/2016] [Accepted: 04/19/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Severe growth hormone deficiency (GHD) leads to several metabolic effects in the body ranging from abnormal body composition to biochemical disturbances. However, less is known regarding these parameters in short children with GH peak levels in the lower normal range during provocation tests. Our aim was to study the metabolic profile of this group and compare it with that of healthy children of normal height. DESIGN Thirty-five pre-pubertal short children (<-2.5 SDS) aged between 7 and 10years, with peak levels of GH between 7 and 14μg/L in an arginine insulin tolerance test (AITT), were compared with twelve age- and sex-matched children of normal height. The metabolic profile of the subjects was analysed by blood samples, DEXA, frequently sampled intravenous glucose tolerance test, microdialysis and stable isotope examinations of rates of glucose production and lipolysis. RESULTS There were no overall significant metabolic differences between the groups. However, in the subgroup analysis, the short children with GH peaks <10μg/L had significantly lower fasting insulin levels which also correlated to other metabolic parameters. CONCLUSION The short pre-pubertal children with GH peak levels between 7 and 14μg/L did not differ significantly from healthy children of normal height but subpopulations within this group show significant metabolic differences.
Collapse
Affiliation(s)
- Anders Tidblad
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, H2:00, SE-17176 Stockholm, Sweden.
| | - Jan Gustafsson
- Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, B62, SE-141 86 Stockholm, Sweden.
| | - Martin Ritzén
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, H2:00, SE-17176 Stockholm, Sweden.
| | - Klas Ekström
- Division of Pediatric Endocrinology, Department of Women's and Children's Health, Karolinska Institutet, H2:00, SE-17176 Stockholm, Sweden.
| |
Collapse
|
6
|
Poyrazoğlu Ş, Akçay T, Arslanoğlu İ, Atabek ME, Atay Z, Berberoğlu M, Bereket A, Bideci A, Bircan İ, Böber E, Can Ş, Cesur Y, Darcan Ş, Demir K, Dündar B, Ersoy B, Esen İ, Güven A, Kara C, Keskin M, Kurtoğlu S, Memioğlu N, Özbek MN, Özgen T, Sarı E, Şıklar Z, Şimşek E, Turan S, Yeşilkaya E, Yüksel B, Darendeliler F. Current practice in diagnosis and treatment of growth hormone deficiency in childhood: a survey from Turkey. J Clin Res Pediatr Endocrinol 2015; 7:37-44. [PMID: 25800474 PMCID: PMC4439890 DOI: 10.4274/jcrpe.1794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Approaches to diagnosis and treatment of growth hormone deficiency (GHD) in children vary among countries and even among centers in the same country. This survey, aiming to facilitate the process of preparing the new consensus on GHD by the Turkish Pediatric Endocrinology and Diabetes Society, was designed to evaluate the current practices in diagnosis and treatment of GHD in different centers in Turkey. METHODS A questionnaire covering relevant items for diagnosis and treatment of GHD was sent out to all pediatric endocrinology centers. RESULTS Twenty-four centers returned the questionnaire. The most frequently used GH stimulation test was L-dopa, followed by clonidine. Eighteen centers used a GH cut-off value of 10 ng/mL for the diagnosis of GHD; this value was 7 ng/mL in 4 centers and 5 ng/mL in 2 centers. The most frequently used assay was immunochemiluminescence for determination of GH, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 concentrations. Sex steroid priming in both sexes was used by 19 centers. The most frequently used starting dose of recombinant human GH (rhGH) in prepubertal children was 0.025-0.030 mg/kg/day and 0.030-0.035 mg/kg/day in pubertal children. Growth velocity was used in the evaluation for growth response to rhGH therapy in all centers. Anthropometric measurements of patients every 3-6 months, fasting blood glucose, bone age and thyroid panel evaluation were used by all centers at follow-up. Main indications for cessation of therapy were decreased height velocity and advanced bone age. Fourteen centers used combined treatment (rhGH and gonadotropin-releasing analogues) to increase final height. CONCLUSION Although conformity was found among centers in Turkey in current practice, it is very important to update guideline statements and to modify, if needed, the approach to GHD over time in accordance with new evidence-based clinical studies.
Collapse
Affiliation(s)
- Şükran Poyrazoğlu
- İstanbul University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey. Phone: +90 414 20 00/31645 E-mail:
| | - Teoman Akçay
- Bakırköy Dr. Sadi Konuk Research and Training Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - İlknur Arslanoğlu
- Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Mehmet Emre Atabek
- Necmettin Erbakan University Faculty of Medicine, Department of Pediatric Endocrinology, Konya, Turkey
| | - Zeynep Atay
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Aysun Bideci
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - İffet Bircan
- Akdeniz University Faculty of Medicine, Department of Pediatric Endocrinology, Antalya, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Şule Can
- Tepecik Educational and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Yaşar Cesur
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dr. Behçet Uz Children Disease and Surgery Training and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Bumin Dündar
- Tepecik Educational and Research Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey
| | - Betül Ersoy
- Celal Bayar University Faculty of Medicine, Department of Pediatric Endocrinology, Manisa, Turkey
| | - İhsan Esen
- Fırat University Faculty of Medicine, Department of Pediatric Endocrinology, Elazığ, Turkey
| | | | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Mehmet Keskin
- Gaziantep University Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep, Turkey
| | - Selim Kurtoğlu
- Erciyes University Faculty of Medicine, Department of Pediatric Endocrinology, Kayseri, Turkey
| | - Nihal Memioğlu
- American Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Mehmet Nuri Özbek
- Diyarbakır Children’s State Hospital and Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - Tolga Özgen
- Bezmialem Vakıf University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Erkan Sarı
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Enver Şimşek
- Osman Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Eskişehir, Turkey
| | - Serap Turan
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ediz Yeşilkaya
- Gülhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
| | - Feyza Darendeliler
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| |
Collapse
|
7
|
Affiliation(s)
- Garland A Campbell
- Division of Nephrology, University of Virginia Health Sciences Center, Charlottesville, Virginia
| | | |
Collapse
|
8
|
Wagner IV, Paetzold C, Gausche R, Vogel M, Koerner A, Thiery J, Arsene CG, Henrion A, Guettler B, Keller E, Kiess W, Pfaeffle R, Kratzsch J. Clinical evidence-based cutoff limits for GH stimulation tests in children with a backup of results with reference to mass spectrometry. Eur J Endocrinol 2014; 171:389-97. [PMID: 24966174 DOI: 10.1530/eje-14-0165] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Cutoff limits of GH stimulation tests to diagnose GH deficiency (GHD) in children and adolescents are not sufficiently validated by clinical studies due to discrepancies in the performance of GH immunoassays and lack of available study populations. OBJECTIVE We aimed to establish new cutoff limits for GH stimulation tests based on clinical evidence and compared these immunoassay-based values with an antibody-independent mass spectrometric method. DESIGN AND SETTING In a retrospective study, GH cutoff limits for eight different immunoassays and isotope dilution mass spectrometry (ID-MS) were calculated from hGH peak concentrations of short-statured children with and without GHD. PATIENTS We compared the serum GH peak concentrations at GH stimulation test of 52 short-statured children and adolescents, who have normal GH secretion at initial workup and normal growth in the follow-up, with the serum GH peak concentrations of 44 GHD patients in the same age range, in order to optimize the cutoff limit calculation. RESULTS Discriminant analysis of re-measured GH led to a new cutoff limit of 7.09 μg/l using the iSYS assay (IDS) and the limits for the other seven hGH assays varied between 4.32 and 7.77 μg/l. For ID-MS, cutoffs of 5.48 μg/l (22k GH) and 7.43 μg/l (total GH) were ascertained. CONCLUSION The establishment of method-specific clinical evidence-based GH cutoff limits is of importance to ensure adequate clinical diagnosis and treatment of children and adolescents with GHD. ID-MS may become an important tool for providing both reliable and sustainable SI traceability of GH measurements in the future.
Collapse
Affiliation(s)
- I V Wagner
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - C Paetzold
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - R Gausche
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - M Vogel
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - A Koerner
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - J Thiery
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - C G Arsene
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - A Henrion
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - B Guettler
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - E Keller
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - W Kiess
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - R Pfaeffle
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| | - J Kratzsch
- Centre for Paediatric Research Leipzig (CPL)Hospital for Children and Adolescents, University of Leipzig, Leipzig, GermanyInstitute for Laboratory MedicineClinical Chemistry and Molecular Diagnostics, University of Leipzig, Paul-List-Straße 13-15, 04103 Leipzig, GermanyCrescNet GmbHUniversity of Leipzig, Leipzig, GermanyPhysikalisch-Technische Bundesanstalt (PTB)Braunschweig, Germany
| |
Collapse
|
9
|
Garcia JM, Swerdloff R, Wang C, Kyle M, Kipnes M, Biller BMK, Cook D, Yuen KCJ, Bonert V, Dobs A, Molitch ME, Merriam GR. Macimorelin (AEZS-130)-stimulated growth hormone (GH) test: validation of a novel oral stimulation test for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab 2013; 98:2422-9. [PMID: 23559086 PMCID: PMC4207947 DOI: 10.1210/jc.2013-1157] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT In the absence of panhypopituitarism and low serum IGF-I levels, the diagnosis of adult GH deficiency (AGHD) requires confirmation with a GH stimulation test. Macimorelin is a novel, orally active ghrelin mimetic that stimulates GH secretion. OBJECTIVE The objective of the study was to determine the diagnostic efficacy and safety of macimorelin in AGHD. DESIGN This was a multicenter open-label study comparing the diagnostic accuracy of oral macimorelin with that of arginine+GHRH in AGHD patients and healthy, matched controls. After 43 AGHD patients and 10 controls were tested, the GHRH analog Geref Diagnostic [GHRH(1-29)NH2] became unavailable in the United States. The study was completed by testing 10 additional AGHD patients and 38 controls with macimorelin alone. MAIN OUTCOME MEASURE Peak GH area under the receiver operating characteristic curve after macimorelin was measured. RESULTS Fifty AGHD subjects and 48 controls were evaluated. Peak GH levels in AGHD patients and controls after macimorelin were 2.36 ± 5.69 and 17.71 ± 19.11 ng/mL, respectively (P < .0001). With macimorelin, the receiver operating characteristic analysis yielded an optimal GH cut point of 2.7 ng/mL, with 82% sensitivity, 92% specificity, and 13% misclassification rate. For subjects receiving both tests, macimorelin showed discrimination comparable with arginine+GHRH (area under the receiver operating characteristic curve 0.99 vs 0.94, respectively, P = .29). Obesity (body mass index > 30 kg/m(2)) was present in 58% of subjects, and peak GH levels were inversely associated with body mass index in controls (r = -0.37, P = .01). Using the separate cut points of 6.8 ng/mL for nonobese and 2.7 for obese subjects reduced the misclassification rate to 11%. Only 1 drug-related serious adverse event, an asymptomatic QT interval prolongation on the electrocardiogram, was reported. CONCLUSION Oral macimorelin is safe, convenient, and effective in diagnosing AGHD with accuracy comparable with the arginine+GHRH test.
Collapse
Affiliation(s)
- J M Garcia
- Division of Endocrinology, Diabetes, and Metabolism, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard, Building 109, Room 210, Houston, Texas 77030, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Yoshihara T, Naito H, Kakigi R, Ichinoseki-Sekine N, Ogura Y, Sugiura T, Katamoto S. Heat stress activates the Akt/mTOR signalling pathway in rat skeletal muscle. Acta Physiol (Oxf) 2013; 207:416-26. [PMID: 23167446 DOI: 10.1111/apha.12040] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/30/2012] [Accepted: 11/12/2012] [Indexed: 12/31/2022]
Abstract
AIM It is well known that various stimuli, such as mechanical stress and nutrients, induce muscle hypertrophy thorough the Akt/mTOR signalling pathway, which is a key mediator of protein synthesis and hypertrophy in skeletal muscle. It was recently reported that heat stress also induces an increase in muscle weight and muscle protein content. In addition, heat stress enhances Akt/mTOR signalling after one bout of resistance exercise. However, it remains unclear whether increased temperature itself stimulates the Akt/mTOR signalling pathway. METHODS Forty-two male Wistar rats (279.5 ± 1.2 g) were divided into a control group (CON) or one of five thermal stress groups at 37, 38, 39, 40 or 41 °C (n = 7 each group). After overnight fasting, both legs were immersed in different temperatures of hot water for 30 min under sodium pentobarbital anaesthesia. The soleus and plantaris muscles were immediately removed from both legs after the thermal stress. RESULTS The phosphorylation of mTOR or 4E-BP1 and heat shock protein (HSP) expression levels were similar among groups in both the soleus and plantaris muscles. However, Akt and p70S6K phosphorylation significantly increased at 41 °C in the soleus and plantaris muscles. Moreover, we observed a temperature-dependent increase in Akt and p70S6K phosphorylation in both muscles. CONCLUSION Our data indicate that the altered temperature increased phosphorylation in a temperature-dependent manner in rat skeletal muscle and may itself be a key stimulator of Akt/mTOR signalling.
Collapse
Affiliation(s)
| | - H. Naito
- Graduate School of Health and Sports Science; Juntendo University; Inzai; Chiba; Japan
| | - R. Kakigi
- Institute of Health and Sports Science & Medicine; Juntendo University; Inzai; Chiba; Japan
| | - N. Ichinoseki-Sekine
- Institute of Health and Sports Science & Medicine; Juntendo University; Inzai; Chiba; Japan
| | - Y. Ogura
- Department of Physiology; St. Marianna University School of Medicine; Kawasaki; Kanagawa; Japan
| | - T. Sugiura
- Department of Exercise and Health Sciences; Faculty of Education; Yamaguchi University; Yamaguchi; Yamaguchi; Japan
| | - S. Katamoto
- Graduate School of Health and Sports Science; Juntendo University; Inzai; Chiba; Japan
| |
Collapse
|
11
|
Fernández-Pérez L, Nóvoa J, Ståhlberg N, Santana-Farré R, Boronat M, Marrero D, Henríquez-Hernández L, Norstedt G, Flores-Morales A. The effect of in vivo growth hormone treatment on blood gene expression in adults with growth hormone deficiency reveals potential biomarkers to monitor growth hormone therapy. Clin Endocrinol (Oxf) 2010; 72:800-6. [PMID: 19849699 DOI: 10.1111/j.1365-2265.2009.03732.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Growth hormone (GH) replacement therapy is presently utilized in the treatment of adult GH deficiency (AGHD). Adult responses to GH treatment are highly variable and, apart from measurement of IGF-I, few tools are currently available for monitoring GH treatment progress. As GH receptors are expressed in certain blood cell types, changes in gene expression in peripheral blood can reflect perturbations induced as a result of GH therapy. DESIGN/PATIENTS We have carried out a pilot study to identify GH-responsive genes in blood, and have assessed the utility of GH-responsive genes in monitoring GH therapy in AGHD. Blood was collected from ten women diagnosed with AGHD syndrome both before and 4 weeks after initiation of GH substitutive therapy. RNA was extracted from peripheral blood mononuclear cells (PBMCs) and changes in response to GH were detected using microarray-based gene analysis. RESULTS All patients responded to GH replacement therapy, with serum levels of IGF-I increasing by an average of 307% (P = 0.0003) while IGFBP-3 increased by an average of 182% (P = 0.0002). Serum levels of triglycerides, LDL-C, HDL-C, APOA1 or APOB did not change after 1 month of GH treatment. By contrast, we detected an increase in Lp(a) serum levels (P = 0.0149). Using a stringent selection cutoff of P <or= 0.05, paired analysis identified a set of transcripts that correlated with GH administration. We applied the multivariate statistical technique PLS-DA to the changes in gene expression, demonstrating their utility in differentiating untreated patients and those undergoing GH replacement therapy. CONCLUSION This study shows that GH-dependent effects on gene expression in PBMCs can be detected by microarray-based gene analysis, and our results establish a foundation for the further exploration of peripheral blood as a surrogate to detect exposure to GH therapy.
Collapse
Affiliation(s)
- L Fernández-Pérez
- Department of Clinical Sciences, Molecular and Translational Endocrinology Group, University of Las Palmas de GC, Canary Islands, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Ftaiti F, Jemni M, Kacem A, Zaouali MA, Tabka Z, Zbidi A, Grélot L. Effect of hyperthermia and physical activity on circulating growth hormone. Appl Physiol Nutr Metab 2008; 33:880-7. [DOI: 10.1139/h08-073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of this study was to differentiate the effects of hyperthermia and physical activity on circulating growth hormone (GH) secretion. Nine healthy volunteer adults performed two 40 min exercise trials and two 50 min passive standing trials. The exercise was performed in either thermo-neutral (N-Ex: air temperature 18 °C, air humidity 40%, and wet bulb globe temperature (WBGT) 17.7 °C) or hot environmental conditions (H-Ex: air temperature 33 °C, air humidity 30%, and WBGT 34.6 °C). The passive exposure trials were also performed in either a comfortable (N-P: air temperature 18 °C, air humidity 40%, and WBGT 17.7 °C) or a hot climatic chamber (H-P: air temperature 40 °C, air humidity 100%, and WBGT 97.1 °C). Plasma GH, plasma volume (PV), tympanic temperature (Tty), and body mass loss (BML) were measured before and after each trial. The decrease in PV was significantly higher during H-Ex and H-P sessions than during N-Ex and N-P sessions. Comparisons showed significantly lower BML in the N-Ex session (1.5% ± 0.3%) than in the H-Ex and H-P sessions (2.1% ± 0.3% and 1.9% ± 0.2%, respectively) (p < 0.001). The rise in Tty was significantly higher during the H-P session (2.9 ± 0.4 °C) (p < 0.001) when compared with the other sessions. Plasma GH concentration increased significantly during all the trials, particularly during the H-Ex session (45 ± 7 ng·mL–1) (p < 0.01). Both exercise and heat exposure, separately, are sufficient to increase significantly the plasma GH concentration, and their combined effect induced a highly synergistic rise in GH.
Collapse
Affiliation(s)
- Foued Ftaiti
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Monem Jemni
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Asma Kacem
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Monia Ajina Zaouali
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Zouhair Tabka
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Abdelkarim Zbidi
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| | - Laurent Grélot
- Research Unit: Psycho-Cultural and Biological Determinants of the High Performance in Young People, Institute of Sport and Physical Education, Sfax, Tunisia
- Department of Physiology and Functional Explorations, IBN EL JAZZAR Medicine Faculty, Sousse 4000, Tunisia
- Centre for Sport and Exercise Sciences, Faculty of Science, University of Greenwich, UK
- UPRES EA 3285, Department of Biology of Physical Activity, University of the Mediterranean, Marseilles, France
| |
Collapse
|
13
|
Savastano S, Di Somma C, Belfiore A, Guida B, Orio F, Rota F, Savanelli MC, Cascella T, Mentone A, Angrisani L, Lombardi G, Colao A. Growth hormone status in morbidly obese subjects and correlation with body composition. J Endocrinol Invest 2006; 29:536-43. [PMID: 16840832 DOI: 10.1007/bf03344144] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Morbidly obese subjects are characterized by multiple endocrine abnormalities and these are paralleled by unfavorable changes in body composition. In obese individuals, either 24-h spontaneous or stimulated GH secretion is impaired without an organic pituitary disease and the severity of the secretory defect is proportional to the degree of obesity. The GHRH+arginine (GHRH+ARG) test is likely to be the overall test of choice in clinical practice to differentiate GH deficiency (GHD) patients. Similarly to other provocative tests, GHRH+ARG is influenced by obesity per se. Therefore, a new cut-off limit of peak GH response of 4.2 microg/l in obese subjects has been recently assumed. The aim of the present study was to investigate the reciprocal influence between decreased GH secretion and body composition in a group of 110 morbidly obese subjects, using the new cut-off limit of peak GH response to GHRH+ARG test for these subjects. In our study, GHD was identified in 27.3% of the obese subjects, without gender difference. In GDH obese subjects body mass index (BMI), waist circumference, waist-to-hip ratio (WHR), fat mass (FM), and resistance (R) were higher while reactance (Xc), phase angle, body cell mass (BCM), IGF-I, or IGF-I z-scores were lower than in normal responders (p<0.001). In all obese subjects, GH peak levels showed a negative correlation with age, BMI, waist circumference and FM, and a positive correlation with IGF-I. In the stepwise multiple linear regression, waist circumference and FM were the major determinants of GH peak levels and IGF-I. In conclusion, using the new cut-off limit of peak GH response to GHRH+ARG test for obese subjects, about 1/3 morbidly obese subjects were GHD. GHD subjects showed a significantly different body composition compared with normal responders, and the secretory defect was correlated to different anthropometric variables with waist circumference and FM as the major determinants.
Collapse
Affiliation(s)
- S Savastano
- Division of Endocrinology, Department of Molecular and Clinical Endocrinology and Oncology, University Federico II, Naples, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Pellecchia MT, Pivonello R, Salvatore E, Faggiano A, Barone P, De Michele G, Lombardi G, Colao A, Filla A. Growth hormone response to arginine test distinguishes multiple system atrophy from Parkinson's disease and idiopathic late-onset cerebellar ataxia. Clin Endocrinol (Oxf) 2005; 62:428-33. [PMID: 15807873 DOI: 10.1111/j.1365-2265.2005.02237.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Multiple system atrophy (MSA) is difficult to distinguish from idiopathic Parkinson's disease (PD) and idiopathic late-onset cerebellar ataxia (ILOCA). This study aimed to evaluate GH response to three different GH stimulation tests in order to establish a reliable test to differentiate these degenerative disorders. DESIGN Twelve patients with MSA, 10 with PD, eight with ILOCA and 30 healthy controls entered the study. They were submitted to clonidine, arginine, and GH-releasing-hormone (GHRH) + arginine tests in a random manner on three different nonconsecutive days. The peak serum GH response was used as a primary variable for analysis of stimulation tests. By ROC analysis, the optimum cut-off level was considered as the cut-off with the maximal sum of sensitivity and specificity. RESULTS After clonidine administration, GH peak was significantly lower in patients with MSA than in those with ILOCA (P < 0.05) and in the controls (P < 0.001). At the optimum cut-off level of 5 mU/l, the clonidine test distinguished patients with MSA from those with PD with a sensitivity and specificity of 78%. Moreover, this test distinguished patients with MSA from those with ILOCA with a sensitivity of 100% and a specificity of 75% at a cut-off level of 5 mU/l, and with a sensitivity of 75% and a specificity of 100% at the cut-off level of 7.6 mU/l. After arginine administration, the GH peak was significantly lower in patients with MSA than in those with ILOCA (P = 0.001) and in controls (P < 0.001). At the optimum cut-off level of 5 mU/l, the arginine test distinguished patients with MSA from those with PD with a sensitivity and a specificity of 100%. At a GH peak cut-off value of 3.6 mU/l the arginine test distinguished patients with MSA from those with ILOCA with a sensitivity and specificity of 100%. After GHRH + arginine administration, a significant GH increase was found in all groups of patients and controls. CONCLUSIONS The GH response to arginine administration is impaired in MSA. Therefore, the arginine test showed the highest diagnostic accuracy to distinguish MSA from both PD and ILOCA, and could be used in the clinical practice of these neurodegenerative diseases.
Collapse
|
15
|
Aimaretti G, Corneli G, Rovere S, Granata R, Baldelli R, Grottoli S, Ghigo E. Insulin-Like Growth Factor I Levels and the Diagnosis of Adult Growth Hormone Deficiency. Horm Res Paediatr 2005; 62 Suppl 1:26-33. [PMID: 15761229 DOI: 10.1159/000080755] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The current guidelines state that, within the appropriate clinical context, the diagnosis of adult growth hormone (GH) deficiency must be made biochemically using provocative tests. Measurement of insulin-like growth factor I (IGF-I) and binding protein 3 (IGFBP-3) levels cannot always distinguish between healthy and GH-deficient individuals. In particular, IGFBP-3 as a marker of GH status is clearly less sensitive than IGF-I and there is general agreement that its measurement does not provide useful diagnostic information. However, the diagnostic value of measuring IGF-I levels has been revisited recently. It has been confirmed that normal IGF-I levels do not rule out severe GH deficiency (GHD) in adults, in whom the diagnosis has therefore to be based on the demonstration of severe impairment of the peak GH response to provocative tests. It has also been emphasized that very low IGF-I levels in patients with high suspicion of GHD could be considered to be definite evidence for severe GHD. This assumption particularly applies to patients with childhood-onset, severe GHD or with multiple hypopituitary deficiencies acquired in adulthood. In addition, the use of IGF-I levels to monitor the efficacy and adequacy of recombinant human GH replacement remains widely accepted.
Collapse
Affiliation(s)
- Gianluca Aimaretti
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|