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

Markkanen, Helene; Pekkarinen, Tuula; Hämäläinen, Esa; Välimäki, Matti; Alfthan, Henrik; Stenman, Ulf‐Håkan

doi:10.1016/j.ghir.2017.07.002

Cited by 3 publications

(4 citation statements)

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“…Current pediatric guidelines do not mention sex in the interpretation of GH stimulation test results of children referred for short stature [3,4]. Moreover, recently published studies in children with short stature do not report sex differences in results of GH stimulation tests [93], although sex differences have been reported in adults undergoing GHRH þ arginine tests [94]. Given that the weighted mean age of participants was 10.2 years, i.e.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on growth hormone stimulation tests in children and adolescents: a systematic review and meta-analysis

Abawi

Augustijn

Hoeks

et al. 2021

Critical Reviews in Clinical Laboratory Sciences

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Section: Discussionmentioning

confidence: 99%

Impact of body mass index on growth hormone stimulation tests in children and adolescents: a systematic review and meta-analysis

Abawi

Augustijn

Hoeks

et al. 2021

Critical Reviews in Clinical Laboratory Sciences

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“…In contrast to healthy men and women, IGF1 levels in GH-deficient adults are lower in women than in men ( 124 ). When healthy adults underwent GHRH plus arginine and arginine tests, several investigators found that peak GH levels are higher in females than males within the same BMI category ( 125 , 126 ). Thus, if sex differences are not taken into account, then males are at greater risk of being overdiagnosed with GHD.…”

Section: Individual Patient Considerationsmentioning

confidence: 99%

“…Furthermore, oral estrogen administration increases integrated GH concentration both in healthy pre-and postmenopausal women by virtue of lesser negative feedback due to lowered hepatic IGF1 generation (123). In contrast to healthy men and women, IGF1 levels in GH-deficient adults are lower in women than in men (124). When healthy adults underwent GHRH plus arginine and arginine tests, several investigators found that peak GH levels are higher in females than males within the same BMI category (125,126).…”

Section: Agementioning

confidence: 99%

Diagnosis and testing for growth hormone deficiency across the ages: a global view of the accuracy, caveats, and cut-offs for diagnosis

Yuen

Johannsson

Miller

et al. 2023

Endocrine Connections

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Growth hormone deficiency (GHD) is a clinical syndrome that can manifest either as isolated or associated with additional pituitary hormone deficiencies. Although diminished height velocity and short stature are useful and important clinical markers to consider testing for GHD in children, the signs and symptoms of GHD are not always so apparent in adults. Quality of life and metabolic health are often impacted in patients with GHD; thus, making an accurate diagnosis is important so that appropriate GH replacement therapy can be offered to these patients. Screening and testing for GHD require sound clinical judgment that follows after obtaining a complete medical history of patients with a hypothalamic-pituitary disorder and thorough physical examination with specific features for each period of life, while targeted biochemical testing and imaging are required to confirm the diagnosis. Random measurements of serum GH levels are not recommended to screen for GHD (except in neonates) as endogenous GH secretion is episodic and pulsatile throughout the lifespan. One or more GH stimulation tests may be required, but existing methods of testing might be inaccurate, difficult to perform, and can be imprecise. Furthermore, there are multiple caveats when interpreting test results including individual patient factors, differences in peak GH cut-offs (by age and test), testing time points, and heterogeneity of GH and IGF-I assays. In this article, we provide a global overview of the accuracy and cut-offs for diagnosis of GHD in children and adults, and discuss the caveats in conducting and interpreting these tests.

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“…These results indicated that stimulated GH studies allowed simulation of the dosage, as well as the therapeutic effects against acromegaly, based on early research and development stages. Our study was conducted exclusively for males in all species tested since the GH response to stimulation by GHRH + arginine is sex-dependent (Markkanen et al, 2017). Our studies reflected the E-R relationship of male and female patients with acromegaly, but an important limitation is the limited background of subjects in our studies.…”

Section: Discussionmentioning

confidence: 99%

Novel Platform for Predicting Drug Effects in Patients with Acromegaly: Translational Exposure-Response Evaluation of Growth Hormone–Inhibitory Effect of Octreotide after Growth Hormone–Releasing Hormone Stimulation

Iida

Komagata

Nagasawa

et al. 2021

J Pharmacol Exp Ther

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Acromegaly is a chronic systemic disease characterized by facial and peripheral changes caused by soft tissue overgrowth, together with multiple complications. Despite available surgical and medical therapies, suitable treatments for acromegaly are still lacking.Efficient drug development requires an understanding of the exposure-response (E-R) relationship based on non-clinical and early clinical studies. We aimed to establish a platform to facilitate the development of novel drugs to treat acromegaly. We evaluated the E-R relationship of the growth hormone (GH)-inhibitory effect of the somatostatin analogue, octreotide, under growth hormone-releasing hormone (GHRH) + arginine stimulation in healthy participants and compared the results with historical data for patients with acromegaly. This randomized five-way crossover study included two placebo and three active-treatment periods with different doses of octreotide acetate. GH secretion in the two placebo periods was comparable, confirming the reproducibility of the response with no carryover effect. GH secretion was inhibited by low-, medium-, and high-dose octreotide acetate, in a dose-dependent manner. We also examined the E-R relationship in monkeys as a preclinical drug evaluation study and in rats as a more convenient and simple system for screening candidate drugs. The E-R relationships and EC50 values were similar among animals, healthy participants and patients with acromegaly, which suggests that GH stimulation studies in early research and development stages allowed simulation of the drug responses in patients with acromegaly.

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

Cited by 3 publications

References 30 publications

Impact of body mass index on growth hormone stimulation tests in children and adolescents: a systematic review and meta-analysis

Impact of body mass index on growth hormone stimulation tests in children and adolescents: a systematic review and meta-analysis

Diagnosis and testing for growth hormone deficiency across the ages: a global view of the accuracy, caveats, and cut-offs for diagnosis

Novel Platform for Predicting Drug Effects in Patients with Acromegaly: Translational Exposure-Response Evaluation of Growth Hormone–Inhibitory Effect of Octreotide after Growth Hormone–Releasing Hormone Stimulation

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