The Influence of Body Mass Index on the Growth Hormone Peak Response regarding Growth Hormone Stimulation Tests in Children

Thieme, Friedemann; Vogel, Mandy; Gausche, Ruth; Beger, Christoph; Vasilakis, Ioannis-Anargyros; Kratzsch, Jürgen; Körner, Antje; Kieß, Wieland; Pfäffle, Roland

doi:10.1159/000526240

Cited by 4 publications

(5 citation statements)

References 33 publications

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Section: Individual Patient Considerationsmentioning

confidence: 99%

“…( 160 ), they noted a negative correlation between BMI SDS and peak GH responses to a GH secretagogue, with each increase in BMI-SDS of 1 unit associated with a decrease in GH max of ~12%. Thieme et al ( 161 ) sought to further study that correlation to verify it in a larger cohort of children below the 10th percentile for height for age. In a single center with almost 1000 patients, they showed consistently negative associations between BMI-SDS and the maximal GH level with effect size of about β = −1.1.…”

Section: Individual Patient Considerationsmentioning

confidence: 99%

“…For children, the normal range for BMI changes as children grow and mature over the years. Obesity in children is defined as a BMI > 95th percentile (or +1.6 SDS) (159). In a meta-analysis by Abawi et al (160), they noted a negative correlation between BMI SDS and peak GH responses to a GH secretagogue, with each increase in BMI-SDS of 1 unit associated with a decrease in GH max of ~12%.…”

Section: Body Mass Indexmentioning

confidence: 99%

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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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Section: Individual Patient Considerationsmentioning

confidence: 99%

Section: Individual Patient Considerationsmentioning

confidence: 99%

Section: Body Mass Indexmentioning

confidence: 99%

See 1 more Smart Citation

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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“…Loche et al described the contrary influence of BMI on the GH reply to the clonidine stimulation test (15). In the study by Thieme et al, glucagon and arginine tests showed significant differences in GH peak levels; glucagon tests were found to be approximately 2 ng/mL higher on average than arginine tests (16). It was assumed that these distinctions in the GH peak value were owing to the sort of test used by Secco et al (17).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Relationship Between Peak Growth Hormone Response to Growth Hormone Stimulation Tests and Body Mass Index

Er,

Evin

2023

Med Sci Discov

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Objective: A contrary relationship between body mass index (BMI) and growth hormone (GH) secretion has been demonstrated in adults. BMI-specific cutoff levels are suggested for identifying growth hormone deficiency (GHD) in adulthood. However, specific values for BMI and growth hormone stimulation test responses in the childhood age group are not certain. In this research, our purpose was to investigate the relationship between GH peak response and BMI in children who underwent GHST with a pre-diagnosis of GHD. Material and Methods: This was a retrospective study of stimulative GH testing with clonidine and L-dopa performed in 150 children 2–18 year-old with short stature (< -2 SDS) in the Pediatric Endocrinology Unit at Bakırçay University Çiğli Training and Research Hospital from the years of 2018 to 2023. Anthropometric measurements, insulin-like growth factor-1 (IGF-I) and IGFBP- 3 levels, especially peak-stimulated GH, were evaluated. Results: A total of 150 patients [98 boys (65.3%) and 52 girls (34.7%)] were included in the study. The mean age of the individuals during testing was 10.26 ± 3.37 years, mean height standard deviation score (SDS) was -2.64 ± 0.89, mean weight SDS was -1.85 ± 1.01 and mean body mass index (BMI) SDS was -0.47 ± 1.07. Ninety-two of the patients (63%) were prepubertal. The mean value for maximum growth hormone serum level (GHmax) clonidine collected during the growth hormone stimulation test was 4.46 ± 2.83 ng/mL, while the mean value in L-dopa test was 3.29 ± 2.57 ng/mL. There was no statistical distinction in terms of both test responses. The correlation between peak GH and BMI-SDS, in terms of clonidine and L-dopa tests, was significantly negative [β = -0.257 (p = 0.010), β = -0.283 (p = 0.004), respectively]. Age, gender and puberty were not significantly associated with peak GH value. In terms of L-dopa peak GH level, the GH level in group 4 (>1 SDS) was revealed to be statistically lower than that in group 1 (< -1 SDS), nevertheless, similar relationship was not detected for clonidine. Conclusion: In our study, a negative correlation was found between GHmax and BMI-SDS in terms of clonidine and L-dopa tests. Therefore, keeping BMI-SDS in mind when evaluating growth hormone stimulation tests performed in short children may be guiding. Still, future studies are needed to make it a determining factor when deciding on treatment.

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“…There are some factors that they might be associated with GH secretion. Studies showed that heat exposure, physical activity, age, gender, body composition, muscle mass, visceral fat, central adiposity, some hormones, blood glucose, and insulin levels influence GH secretion [ 76 , 77 ]. However, the association between body fat, glucose disposal, and GH secretion remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Growth Hormone Response to L-Arginine Alone and Combined with Different Doses of Growth Hormone-Releasing Hormone: A Systematic Review and Meta-Analysis

Goli

Yazdi

Heidari‐Beni

et al. 2022

International Journal of Endocrinology

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Background. Arginine (ARG) can modulate growth hormone (GH) release by suppressing its endogenous inhibitory regulator, somatostatin. ARG also induces the release of the GH-releasing hormone (GHRH). This study aims to review the effects of L-arginine supplementation alone and combined with GHRH in different doses on GH secretion. Methods. In this systematic review and meta-analysis, an electronic literature search was conducted on Medline database (PubMed), Scopus, and Web of Science databases. All eligible studies were randomized clinical trials that reported the effects of ARG supplementation alone or with GHRH on GH levels. Mean difference (MD) and 95% confidence intervals (CI) were computed as the effect size. Results. Meta-analyses showed significant effects of ARG alone on GH release (MD = 10.07, 95% CI: 7.87, 12.28). Moreover, the response of GH was greater with ARG in combination with GHRH (MD = 24.96, 95% CI: 17.51, 32.42). There was no significant difference between the patients and healthy individuals and between oral and injection use of ARG. The systematic review revealed the important role of ARG in combination with other amino acids on GH secretion in patients with GH deficiency. Conclusion. This study revealed that in GH-deficient individuals, high doses of ARG supplementation in combination with GHRH and/or other amino acids might have potential therapeutic effects on increasing GH concentrations. These findings propose that ARG supplementation can be considered as a potential stimulator in management of GH deficiency.

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The Influence of Body Mass Index on the Growth Hormone Peak Response regarding Growth Hormone Stimulation Tests in Children

Cited by 4 publications

References 33 publications

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

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

Evaluation of the Relationship Between Peak Growth Hormone Response to Growth Hormone Stimulation Tests and Body Mass Index

Growth Hormone Response to L-Arginine Alone and Combined with Different Doses of Growth Hormone-Releasing Hormone: A Systematic Review and Meta-Analysis

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