The Diagnosis of Growth Hormone Deficiency in Children and Adults

Shalet, Stephen M; Toogood, Andrew; Rahim, Asad; Brennan, Bernadette

doi:10.1210/edrv.19.2.0329

Cited by 338 publications

(281 citation statements)

References 156 publications

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“…However, this reliability declines with age and Toogood et al found that only 21% of elderly GHD patients (aged 61-85 years) had a serum IGF1 lower than age-matched controls (22). Therefore, in a young patient IGF1 SDS may be helpful in indicating the presence of GHD, whereas in middle-aged or older patients it is less useful unless unequivocally low in the absence of intercurrent illness and hepatic dysfunction (23)(24)(25).…”

Section: Diagnosismentioning

confidence: 99%

Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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It is now accepted that adults with severe GH deficiency (GHD) demonstrate impaired physical and psychological well-being and may benefit from replacement with recombinant human GH. Postmarketing surveillance surveys, such as the Pfizer International Metabolic Database (KIMS), were initially set-up to provide safety data on long-term treatment but have the added benefit of providing ongoing observational data on the effect of GH replacement on body composition, lipid and glucose status, hypertension, bone density and quality of life. These data demonstrate that although GHD has clinical impact at all ages, the individual consequences of this condition may take on greater significance at different stages in life. At all ages, accurate, safe diagnosis and appropriate GH dosing are necessary to provide the individual with the best possible outcome.

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Section: Diagnosismentioning

confidence: 99%

Adult GH deficiency throughout lifetime

Thomas

Monson

2009

European Journal of Endocrinology

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“…The diagnosis of growth hormone (GH) deficiency (GHD) during childhood is classically based on clinical assessment, combined with laboratory tests of the GH-insulinlike growth factor (IGF) axis and radiological evaluation (1,2,3). Stimulation tests are commonly used to assess pituitary GH secretory capacity.…”

Section: Introductionmentioning

confidence: 99%

Cut-off limits of the peak GH response to stimulation tests for the diagnosis of GH deficiency in children and adolescents: study in patients with organic GHD

Guzzetti

Ibba

Pilia

et al. 2016

European Journal of Endocrinology

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Objective: The diagnosis of GH deficiency (GHD) in children and adolescents is established when GH concentrations fail to reach an arbitrary cut-off level after at least two provocative tests. The objective of the study was to define the optimal GH cut-offs to provocative tests in children and adolescents. Design: Retrospective study in 372 subjects who underwent evaluation of GH secretion. GH and IGF-I were measured by chemiluminescence assay in all samples. Receiver operating characteristic (ROC) analysis was used to evaluate the optimal GH cut-offs and the diagnostic accuracy of provocative tests. Methods: Seventy four patients with organic GHD (GH peak <10 µg/L after two provocative tests) and 298 control subjects (GH response >10 µg/L to at least one test) were included in the study. The provocative tests used were arginine, insulin tolerance test (ITT) and clonidine. Diagnostic criteria based on cut-offs identified by ROC analysis (best pair of values for sensitivity and specificity) were evaluated for each test individually and for each test combined with IGF-I SDS. Results: The optimal GH cut-off for arginine resulted 6.5 µg/L, 5.1 µg/L for ITT and 6.8 µg/L for clonidine. IGF-I SDS has low accuracy in diagnosing GHD (AUC = 0.85). The combination of the results of provocative tests with IGF-I concentrations increased the specificity. Conclusions:The results of the ROC analysis showed that the cut-off limits which discriminate between normal and GHD are lower than those commonly employed. IGF-I is characterized by low diagnostic accuracy.

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“…The pressure effects on the optic chiasma will cause visual disturbances and the pressure effects on the mass will cause headache. Endocrine abnormalities are especially pronounced in adult patients, where secretion of growth hormone, gonadotrophins, ACTH and TSH are affected [8].…”

Section: Discussionmentioning

confidence: 99%