The growth hormone deficiency syndrome in adults

Cuneo, Ross C.; Salomon, Franco; McGauley, Gill; Sönksen, Peter H.

doi:10.1111/j.1365-2265.1992.tb02347.x

Cited by 349 publications

(128 citation statements)

References 77 publications

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“…Five GHD subjects (50%) are falsely classified as GH sufficient by IGF-I values, and one GS subject (10%) is falsely classified as GHD. It has previously been demonstrated that circulating IGF-I levels do not provide a reliable marker of GH secretion in adults because they are greatly influenced by nutritional and metabolic status, IGF-I and IGF-binding protein-3 (IGFBP-3) being within the normal range in more than 60% of patients with GH deficiency (11,12).…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of growth hormone deficiency in adults by testing with GHRP-6 alone or in combination with GHRH: comparison with the insulin tolerance test

Petersenn

Jung²,

Beil³

2002

European Journal of Endocrinology

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Objective: The diagnosis of GH deficiency in adults should be made using provocative testing of GH secretion. The insulin tolerance test (ITT) is recommended as the gold standard investigation. Because of the risk of serious complications, patients with epilepsy or known ischemic heart disease should not undergo this test. GHRP-6 is a synthetic hexapeptide that releases GH by binding to specific hypothalamic and pituitary receptors. We assessed the diagnostic capability of GH stimulation by GHRP-6 alone or in combination with GHRH in comparison to the results of an ITT. Design: Twenty patients underwent an ITT for suspected pituitary or adrenal disease. Either GHRP-6 (1 mg/kg) alone, or GHRP-6 in combination with GHRH (1 mg/kg) were administered on different days. Blood samples were obtained during a subsequent 90-min period for measurement of GH. Results: Ten patients had a GH peak response of less than 3 mg/l during ITT and were considered growth hormone deficient (GHD). The GH mean peak (^S.E.M., range) in this group was 0.7 mg/l (^0.3, 0.1 -2.9) compared with 14.5 mg/l (^3.5, 3.8 -40.8) in the group of patients with a GH peak response of more than 3 mg/l (growth hormone sufficient (GS)). For the GHRP-6 test, the GH mean peak was 1.3 mg/l (^0.6, 0.1 -6.7) in the GHD group versus 25.7 mg/l (^5.5, 7.7-54.2) in the GS group. After GHRP-6 þ GHRH, the GH mean peaks were 4.0 mg/l (^1.3, 0.2 -11.9) versus 54.7 mg/l (^11.1, 13.9 -136.0) respectively. During administration of GHRP-6, the only side effects observed were flush symptoms. Conclusions: Peak GH levels below 7 mg/l for the GHRP-6 test and below 13 mg/l for the combined GHRP-6 þ GHRH test identified all patients with GH deficiency correctly as defined by ITT. The results suggest that testing with GHRP-6 or GHRP-6 þ GHRH is as sensitive and specific as an ITT for the diagnosis of adult GH deficiency.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of growth hormone deficiency in adults by testing with GHRP-6 alone or in combination with GHRH: comparison with the insulin tolerance test

Petersenn

Jung²,

Beil³

2002

European Journal of Endocrinology

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“…In 1995, GH treatment in adults with severe GHD was approved in Europe and in 1996 in the United States (2,3). This approval was based on studies showing that GHD in adults is associated with adverse clinical symptoms such as an abnormal body composition with increased fat mass and reduced lean body mass, reduced muscle strength and physical performance, decreased bone mineral density, an adverse lipid profile and an impaired quality of life (4,5). Treatment with GH was reported to have beneficial effects in GHD adults (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

Nieuwpoort

Bunderen

Arwert

et al. 2011

European Journal of Endocrinology

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Objective: The Dutch National Registry of GH Treatment in Adults was established in 1998 as an initiative of the Ministry of Health. The main goals were to gain more insight into long-term efficacy, safety, and costs of GH therapy (GHT) in adult GH-deficient (GHD) patients in The Netherlands. Methods: Baseline patient characteristics and diagnostic test procedures were evaluated. Results: Until January 2009 in roughly 10 years, 2891 patients (1475 men and 1416 women, mean age 43.5G16.5 years) were registered. GHD was of childhood-onset (CO) in over 20% of the patients and of isolated in 11%. The most common causes of GHD were pituitary tumors and/or their treatment, craniopharyngiomas, and idiopathic GHD. In 85% of the patients, a GH stimulation test was performed, in the majority an insulin tolerance test (ITT) (49%) or a combined GHRH-arginine test (25%). In 12% of the patients, IGF1 levels were %K2 S.D. combined with two or more additional pituitary hormone deficits, and in 2%, it concerned patients with CO-GHD continuing GHT in adulthood. Over the years, the test of first choice shifted from ITT toward GHRH-arginine test. Conclusion: Nearly, 2900 patients were included in the nationwide surveillance database of the Dutch National Registry of GH Treatment in Adults until January 2009. Baseline patient characteristics are comparable to that reported previously. In 85% of these patients, the diagnosis of GHD was established by provocative testing, particularly an ITT or a combined GHRH-arginine test, with an evident increase in the percentage of GHRH-arginine tests being performed in the last years.

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“…This cut-off is lower than that we found, but control subjects studied by Biller et al (34) had a higher body mass index (BMI; 30.3^5.8 kg/m 2 ). It has to be taken into account that nearly half of the patients with acquired hypothalamic-pituitary disease are overweight or obese (3,4,7), indicating the clinical need to define BMI-related cut-off limits of the GH response to provocative tests for the diagnosis of adult GHD. Therefore, the aim of our study was to define appropriate diagnostic cut-off limits of peak GH response to the GHRH-ARG test related to BMI.…”

Section: Introductionmentioning

confidence: 99%

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

et al. 2005

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Objective: The diagnosis of growth hormone (GH) deficiency (GHD) in adults is based on a reduced peak GH response to provocative tests, such as the insulin tolerance test (ITT) and the GH-releasing hormone-arginine (GHRH-ARG) test. However, the cut-off limits of peak GH response in lean subjects are not reliable in obese patients; this is noteworthy since adult GHD is often associated with obesity. Aim of this study was to evaluate the diagnostic cut-off limits of peak GH response to the GHRH-ARG test in overweight and obese as well as in lean population. Design and methods: The GH responses to the GHRH-ARG test were studied in 322 patients with organic hypothalamic-pituitary disease and in 318 control subjects. Patients were subdivided into two groups on the basis of the number of pituitary hormone deficits, except for GH deficiency: (a) patients with total pituitary hormone deficit (TPHD) and (b) patients without or with no more than two pituitary hormone deficits (PHD). Both patients and control subjects were divided into three subgroups according to body mass index (BMI): lean (BMI , 25 kg/m 2 ), overweight (BMI $ 25 and , 30 kg/m 2 ) and obese (BMI $30 kg/m 2 ). TPHD patients were assumed to be GH deficient, whereas PHD patients may include subjects with either normal or impaired GH secretion. The statistical analysis was carried out by the Receiver-Operating Characteristic curve analysis (Medcalc 7.2). The diagnostic cut-off points were calculated for lean, overweight and obese subjects to provide optimal separation of GH-deficient patients and control subjects according to two criteria: (1) a balance between high sensitivity and high specificity; (2) to provide the highest pair of sensitivity/specificity values for GH deficiency. Results: In the lean population the best pair of values, with highest sensitivity as 98.7% and highest specificity as 83.7%, was found using a peak GH cut-off point of 11.5 mg/l. In the overweight population the best pair of values, 96.7 and 75.5%, respectively, was found using a peak GH cut-off point of 8.0 mg/l. In the obese population the best pair of values, 93.5 and 78.3%, respectively, was found using a peak GH cut-off point of 4.2 mg/l. Applying the above mentioned cut-off points, among PHD patients we found that 80 subjects (72%) were GHD whereas 31 (28%) had normal GH secretion. Conclusions: In conclusion the GHRH-ARG test is a reliable tool for the diagnosis of adult GH deficiency in lean, overweight and obese patients, provided that specific BMI-related cut-off limits are assumed.European Journal of Endocrinology 153 257-264

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The growth hormone deficiency syndrome in adults

Cited by 349 publications

References 77 publications

Diagnosis of growth hormone deficiency in adults by testing with GHRP-6 alone or in combination with GHRH: comparison with the insulin tolerance test

Diagnosis of growth hormone deficiency in adults by testing with GHRP-6 alone or in combination with GHRH: comparison with the insulin tolerance test

Dutch National Registry of GH Treatment in Adults: patient characteristics and diagnostic test procedures

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index

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