Limitations of clinical utility of growth hormone stimulating tests in diagnosing children with short stature. 2006

Maciej Hilczer, and Joanna Smyczynska, and Andrzej Lewinski
Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.

OBJECTIVE The diagnosis of growth hormone (GH) deficiency (GHD) is routinely based on the results of two stimulating tests performed with different stimuli. Arbitrarily established, equal cutoff levels for the tests with different pharmacological stimuli, as well as a relatively high incidence of falsely decreased (FD) response in the tests have been reported. Falsely decreased GH response in one of the two performed tests does not exclude FD response in the second one, so, it seems very important to assess the incidence of FD response in both GH stimulating tests. METHODS The analysis comprised the results of two GH stimulating tests (the 1st one with clonidine, the 2nd one with either insulin or glucagon) performed in 780 short children. RESULTS The mean GH peak in the test with clonidine was significantly higher than that in both other tests (p<0.01). The rate of decreased GH secretion was 48.7 % in the test with clonidine, 80.5 % in the test with insulin and 81.5 % in the test with glucagon. Similar frequency of normal and subnormal test results was obtained for the cut-off value for the tests with insulin and with glucagon at the level of 6.4 ng/ml. The correlation between the results of the two tests as performed in particular patients was weak (r=0.27; p<0.05). Following cases of test results were found: 1. both results normal (1st NT, 2nd NT) in 117 patients (15.0 %), 2. 1st result normal, while the 2nd one falsely decreased (1st NT, 2nd FD) in 283 (36.3 %), 3. reverse situation (1st FD, 2nd NT) in 62 (7.9 %), 4. both results decreased in 318 (40.8 %), either truly (1st TD, 2nd TD) or falsely (1st FD, 2nd FD) - with unknown incidence. The following incidences (probabilities - P) result from the above data: A. P(1st NT, 2nd NT) = P(1st NT) intersection P(2nd NT) = 0.150; B. P(1st NT, 2nd FD) = P(1st NT) intersection P(2nd FD) = 0.363; C. P(1st FD, 2nd NT) = P(1st FD) intersection P(2nd NT) = 0.079. The expression (B intersection C)/A was calculated by transforming the right side of the equations: (B x C)/A = 0.192. Thus, 19.2 %, out of all 780 patients, i.e., 150 children (47.2 % of 318 patients, assessed as GH-deficient), could have both test results FD. CONCLUSIONS The observed differences in GH response to particular pharmacological stimuli, as well as the high incidence of falsely decreased GH response in the two stimulating tests, should be taken into account in qualifying short children to GH therapy.

UI MeSH Term Description Entries
D007328 Insulin A 51-amino acid pancreatic hormone that plays a major role in the regulation of glucose metabolism, directly by suppressing endogenous glucose production (GLYCOGENOLYSIS; GLUCONEOGENESIS) and indirectly by suppressing GLUCAGON secretion and LIPOLYSIS. Native insulin is a globular protein comprised of a zinc-coordinated hexamer. Each insulin monomer containing two chains, A (21 residues) and B (30 residues), linked by two disulfide bonds. Insulin is used as a drug to control insulin-dependent diabetes mellitus (DIABETES MELLITUS, TYPE 1). Iletin,Insulin A Chain,Insulin B Chain,Insulin, Regular,Novolin,Sodium Insulin,Soluble Insulin,Chain, Insulin B,Insulin, Sodium,Insulin, Soluble,Regular Insulin
D008297 Male Males
D012016 Reference Values The range or frequency distribution of a measurement in a population (of organisms, organs or things) that has not been selected for the presence of disease or abnormality. Normal Range,Normal Values,Reference Ranges,Normal Ranges,Normal Value,Range, Normal,Range, Reference,Ranges, Normal,Ranges, Reference,Reference Range,Reference Value,Value, Normal,Value, Reference,Values, Normal,Values, Reference
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003000 Clonidine An imidazoline sympatholytic agent that stimulates ALPHA-2 ADRENERGIC RECEPTORS and central IMIDAZOLINE RECEPTORS. It is commonly used in the management of HYPERTENSION. Catapres,Catapresan,Catapressan,Chlophazolin,Clofelin,Clofenil,Clonidine Dihydrochloride,Clonidine Hydrochloride,Clonidine Monohydrobromide,Clonidine Monohydrochloride,Clopheline,Dixarit,Gemiton,Hemiton,Isoglaucon,Klofelin,Klofenil,M-5041T,ST-155,Dihydrochloride, Clonidine,Hydrochloride, Clonidine,M 5041T,M5041T,Monohydrobromide, Clonidine,Monohydrochloride, Clonidine,ST 155,ST155
D003951 Diagnostic Errors Incorrect or incomplete diagnoses following clinical or technical diagnostic procedures. Diagnostic Blind Spots,Errors, Diagnostic,Misdiagnosis,Blind Spot, Diagnostic,Blind Spots, Diagnostic,Diagnostic Blind Spot,Diagnostic Error,Error, Diagnostic,Misdiagnoses
D005188 False Negative Reactions Negative test results in subjects who possess the attribute for which the test is conducted. The labeling of diseased persons as healthy when screening in the detection of disease. (Last, A Dictionary of Epidemiology, 2d ed) False Negative Reaction,Reaction, False Negative,Reactions, False Negative
D005260 Female Females
D005934 Glucagon A 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal GLUCAGON-LIKE PEPTIDES. Glucagon is secreted by PANCREATIC ALPHA CELLS and plays an important role in regulation of BLOOD GLUCOSE concentration, ketone metabolism, and several other biochemical and physiological processes. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p1511) Glucagon (1-29),Glukagon,HG-Factor,Hyperglycemic-Glycogenolytic Factor,Proglucagon (33-61),HG Factor,Hyperglycemic Glycogenolytic Factor
D006130 Growth Disorders Deviations from the average values for a specific age and sex in any or all of the following: height, weight, skeletal proportions, osseous development, or maturation of features. Included here are both acceleration and retardation of growth. Stunted Growth,Stunting,Disorder, Growth,Growth Disorder,Growth, Stunted,Stuntings

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