Anthropometric factors have significant influence on the outcome of the GHRH–arginine test: establishment of normative data for an automated immunoassay specifically measuring 22 kDa human growth hormone

Deutschbein, Timo; Bidlingmaier, Martin; Schopohl, Jochen; Strasburger, Christian J.; Petersenn, Stephan

doi:10.1530/eje-16-0668

Cited by 12 publications

(14 citation statements)

References 42 publications

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“…In accordance with a recent study by Deutschbein et al [14] we found that the peak GH values in the GHRH + ARG test are clearly higher in healthy females than in males within the same BMI group. With the current BMI-related cut-off limits of AGHD, all female controls were classified as GH sufficient, whereas 22% (14/65) of the males were misclassified as insufficient.…”

Section: Discussionsupporting

confidence: 93%

“…The reliability and reproducibility of pharmacological stimulation tests in the diagnosis of GHD are still under discussion. Albeit findings have been somewhat controversial, age and gender obviously also affect the GH response in the GHRH + ARG test [6,8,[11][12][13][14]. Furthermore, there is a significant variation between GH results obtained by assays from different manufactures, which invalidates the use of common cut-off limits [15].…”

Section: Introductionmentioning

confidence: 99%

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Gender has to be taken into account in diagnosing adult growth hormone deficiency by the GHRH plus arginine test

Markkanen

Pekkarinen

Hämäläinen

et al. 2017

Growth Hormone & IGF Research

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Gender has to be taken into account in diagnosing adult growth hormone deficiency by the GHRH plus arginine test

Markkanen

Pekkarinen

Hämäläinen

et al. 2017

Growth Hormone & IGF Research

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“…Our data also provide further evidence that in healthy subjects, GH nadir concentrations as measured by a modern, widely available, automated GH assay which fulfills recent consensus criteria regarding calibration, specificity and sensitivity are much lower than the current cut-offs mentioned in guidelines for the diagnosis and follow-up of acromegaly (7). From studies on GH deficiency, it is known that BMI predicts GH response to GHRH arginine stimulation and that baseline GH tends to be lower in obese as compared to normal weight subjects (34,35,36,37). We could show that also the degree of suppression of GH during OGTT highly depends on BMI (Figs 3 and 5).…”

Section: Discussionmentioning

confidence: 95%

Determinants of the growth hormone nadir during oral glucose tolerance test in adults

Schilbach

Gar

Lechner

et al. 2019

European Journal of Endocrinology

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Objective Growth hormone (GH) nadir (GHnadir) during oral glucose tolerance test (OGTT) is an important tool in diagnosing acromegaly, but data evaluating the need to adjust cut-offs to biological variables utilizing today's assay methods are scarce. We therefore investigated large cohorts of healthy subjects of both sexes to define normal GHnadir concentrations for a modern, sensitive, 22 kD-GH-specific assay. Design Multicenter study with prospective and retrospective cohorts (525 healthy adults: 405 females and 120 males). Methods GH concentrations were measured by the IDS-iSYS immunoassay after oral application of 75 g glucose. Results GHnadir concentrations (µg/L) were significantly higher in lean and normal weight subjects (group A) compared to overweight and obese subjects (group B); (males (M): A vs B, mean: 0.124 vs 0.065, P = 0.0317; premenopausal females without estradiol-containing OC (OC-EE) (FPRE): A vs B, mean: 0.179 vs 0.092, P < 0.0001; postmenopausal women (FPOST): A vs B, mean: 0.173 vs 0.078, P < 0.0061). Age, glucose metabolism and menstrual cycle had no impact on GHnadir. However, premenopausal females on OC-EE (FPREOC) exhibited significantly higher GHnadir compared to all other groups (all P < 0.0001). BMI had no impact on GHnadir in FPREOC (A vs B, mean: 0.624 vs 0.274, P = 0.1228). Conclusions BMI, sex and OC-EE intake are the major determinants for the GHnadir during OGTT in healthy adults. Using a modern sensitive GH assay, GHnadir concentrations in healthy subjects are distinctly lower than cut-offs used in previous guidelines for diagnosis and monitoring of acromegaly.

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“…Results taken from the External Quality Assessment Scheme 4/2017 organized by Reference Institute for Bioanalytics (RfB, Bonn, Germany), one of the two German proficiency testing organizations. More results can be accessed at http://www.rfb.bio significantly lower GH concentrations at baseline and during many stimulation tests, but also exhibit more pronounced suppression of GH secretion during OGTT (26)(27)(28). Furthermore, factors such as stress, sleep, nutritional status, exercise and sex hormones influence GH secretion (…”

Section: Biological Variables In the Interpretation Of Measured Gh Comentioning

confidence: 99%

Laboratory investigations in the diagnosis and follow-up of GH-related disorders

Schilbach¹,

Bidlingmaier²

2019

Archives of Endocrinology and Metabolism

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In addition to auxiological, clinical and metabolic features measurements of growth hormone (GH) and insulin-like growth factor I (IGF-I) complement our tools in diagnosis and follow-up of GH-related disorders. While comparably robust during the pre-analytical phase, measurement and interpretation of concentrations of both hormones can be challenging due to analytical issues and biological confounders. Assay methods differ in terms of antibody specificity, interference from binding proteins, reference preparations and sensitivity. GH assays have different specificity towards different GHisoforms (e.g. 20 kDa GH, placental GH) and interference from the GH antagonist Pegvisomant. The efficacy to prevent binding protein interference is most important in IGF-I assays. Methodological differences between assays require that reference intervals and diagnostic cutoffs are assay-specific. Among biological variables, pubertal development and age are most relevant for IGF-I, making detailed reference intervals mandatory for interpretation. GH has pulsatile secretion and short half-life. Its concentration is modified by acute factors such as stress, exercise and sleep, but also by intake of oral estrogens and anthropometric factors (e.g. BMI). Other GH dependent biomarkers such as free IGF-I, IGF binding protein 3 (IGFBP 3) and acid labile subunit (ALS) have been proposed. Their concentrations largely mirror the information obtained through measurement of IGF-I, but their measurement can be helpful in particular situations. In this review, we describe the evolution of analytical methods to measure biomarkers of GH action, the impact of the methodological changes on laboratory results and the need to include biological variables in their interpretation.

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Anthropometric factors have significant influence on the outcome of the GHRH–arginine test: establishment of normative data for an automated immunoassay specifically measuring 22 kDa human growth hormone

Abstract: BMI and sex account for most of the variability of peak GH levels during GARG. Consequently, diagnostic accuracy of the GARG test is significantly improved by use of adjusted cutoffs.

Cited by 12 publications

References 42 publications

Gender has to be taken into account in diagnosing adult growth hormone deficiency by the GHRH plus arginine test

Gender has to be taken into account in diagnosing adult growth hormone deficiency by the GHRH plus arginine test

Determinants of the growth hormone nadir during oral glucose tolerance test in adults

Laboratory investigations in the diagnosis and follow-up of GH-related disorders

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