The arginine and GHRP-2 tests as alternatives to the insulin tolerance test for the diagnosis of adult GH deficiency in Japanese patients: A comparison

The arginine + GHRH test has been established as an alternative to the insulin tolerance test (ITT) for the diagnosis of adult GH deficiency (AGHD). However, the glucagon, arginine, and GH releasing peptide-2 (GBRP-2) test are recommended as alternatives in Japan. The objective of this study was to evaluate the arginine and GHRP-2 tests as alternatives to the ITT for the diagnosis of AGHD in a Japanese population. Three stimulation tests (ITT, arginine test, and GHRP-2 test) were conducted in 71 pre-operative adult patients with pituitary tumors (age, 18-65 years). The peak GH responses to each test were examined. The peak GH responses were significantly lower with the ARG test (median 4.43 mu g/L) (p < 0.0001) than with the ITT (median 9.38 mu g/L), and the peak GH responses with the GBRP-2 test (median 28.88 mu g/L) were higher (p < 0.0001). However, among the AGIAD patients, there was no significant difference between the peak GH responses to the ARG test and the ITT. The sensitivities and specificities of the ARG / GBRP-2 tests compared to the ITT for the diagnosis of severe AGHD (peak GH responses to ITT <= 1.8 mu g/L) were 93.8% / 81.3% and 85.5% /94.5%, respectively. The arginine and GHRP-2 stimulation tests are acceptable alternatives to the ITT for the diagnosis of AGHD in Japanese patients. The method and criterion for the diagnosis of AGHD should be reconsidered and adjusted to each population.