Diagnostic value of a ghrelin test for the diagnosis of GH deficiency after subarachnoid hemorrhage

Abstract

ObjectiveTo determine the diagnostic value of a ghrelin test in the diagnosis of GH deficiency (GHD) shortly after aneurysmal subarachnoid hemorrhage (SAH).DesignProspective single-center observational cohort study.MethodsA ghrelin test was assessed after the acute phase of SAH and a GH-releasing hormone (GHRH)–arginine test 6 months post SAH. Primary outcome was the diagnostic value of a ghrelin test compared with the GHRH–arginine test in the diagnosis of GHD. The secondary outcome was to assess the safety of the ghrelin test, including patients' comfort, adverse events, and idiosyncratic reactions.ResultsForty-three survivors of SAH were included (15 males, 35%, mean age 56.6±11.7). Six out of 43 (14%) SAH survivors were diagnosed with GHD by GHRH–arginine test. In GHD subjects, median GH peak during ghrelin test was significantly lower than that of non-GHD subjects (5.4 vs 16.6, P=0.002). Receiver operating characteristics analysis showed an area under the curve of 0.869. A cutoff limit of a GH peak of 15 μg/l corresponded with a sensitivity of 100% and a false-positive rate of 40%. No adverse events or idiosyncratic reactions were observed in subjects undergoing a ghrelin test, except for one subject who reported flushing shortly after ghrelin infusion.ConclusionOwing to its convenience, validity, and safety, the ghrelin test might be a valuable GH provocative test, especially in the early phase of SAH.

Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis

“…The majority of them were prospective single-centre studies (N = 15, 75 %), two were prospective multi-centric Criteria for diagnosis of endocrine abnormality differed widely, and included both basal hormone levels and stimulation tests ( Table 2). Five authors studied just a single hormonal axis (somatotropic [10], or adrenal axis [13,[26][27][28]) and the remaining studied multiple hormone alterations.…”

The effect of hypopituitarism on fatigue after subarachnoid hemorrhage

“…The occurrence and course of PD after SAH in the present study have been described elsewhere . Eight respondents with PD in our study suffered from GHD.…”

Hypopituitarism after subarachnoid haemorrhage, do we know enough?

“…Blijdorp et al prospectively analysed 84 patients and reported preliminary data of 43 patients using basal hormonal tests, synacten test when ACTH deficiency was suspected and a ghrelin test in the early phase after SAH and confirmatory GHRH-arg test after six months [ 42 ]. The most prominent methodological shortcomings were the incomplete reports of patient selection [ 17 , 32 , 33 , 35 , 37 , 46 ], selection bias [ 17 , 33 - 35 , 42 , 46 ] and inadequate laboratory testing [ 17 , 33 , 35 , 36 , 38 , 43 , 44 ]. Some studies did not use dynamic tests to determine growth hormone or corticotrophin deficiency [ 17 , 34 , 43 , 44 , 46 ].…”