Cut-off limits of the GH response to GHRH plus arginine test and IGF-I levels for the diagnosis of GH deficiency in late adolescents and young adults

被引:55
作者
Corneli, Ginevra [1 ]
Di Somma, Carolina [2 ]
Prodam, Flavia [1 ]
Bellone, Jaele [3 ]
Bellone, Simonetta [1 ]
Gasco, Valentina [3 ]
Baldellis, Roberto [4 ,6 ]
Rovere, Silvia [3 ]
Schneider, Harald Joern [3 ]
Gargantini, Luigi [5 ]
Gastaldi, Roberto
Ghizzoni, Lucia [7 ]
Valle, Domenico [8 ]
Salerno, Mariacarolina [9 ]
Colao, Annamaria [2 ]
Bona, Gianni [1 ]
Ghigo, Ezio [3 ]
Maghnie, Mohamad [6 ]
Aimaretti, Gianluca [1 ]
机构
[1] Amedeo Avogadro Univ Novara, Dept Clin & Expt Med, Div Pediat, I-28100 Novara, Italy
[2] Univ Naples Federico II, Dept Endocrinol, I-80100 Naples, Italy
[3] Univ Turin, Div Endocrinol & Metab Dis, I-10100 Turin, Italy
[4] Regina Elena Inst Canc Res, Serv Endocrinol, I-00100 Rome, Italy
[5] Hosp Treviglio, Div Pediat Endocrinol, I-24047 Treviglio, Italy
[6] Univ Genoa, IRCCS G Gaslini, Dept Pediat, I-16100 Genoa, Italy
[7] Univ Parma, Div Pediat, I-8100 Parma, Italy
[8] Eli Lilly & Co, Florence, Italy
[9] Univ Naples Federico II, Dept Pediat, Naples, Italy
关键词
D O I
10.1530/EJE-07-0384
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To define the appropriate diagnostic cut-off limits for the GH response to GHRH+arginine (ARG) test and IGF-I levels, using receiver operating characteristics (ROC) curve analysis, in late adolescents and young adults. Design and methods: We studied 152 patients with childhood-onset organic hypothalamic-pituitary disease (85 males, age (mean +/- S.E.M.): 19.2 +/- 0.2 years) and 201 normal adolescents as controls (96 males, age: 20.7 0.2 years). Patients were divided into three subgroups on the basis of the number of the other pituitary hormone deficits, excluding GH deficiency (GHD): subgroup A consisted of 35 panhypopituitary patients (17 males, age: 21.2 +/- 0.4 years), subgroup B consisted of 18 patients with only one or with no more than two pituitary hormone deficits (7 males, age: 20.2 +/- 0.9 years); and subgroup C consisted of 99 patients without any known hormonal pituitary deficits (60 males, age: 18.2 +/- 0.2 years). Both patients and controls were lean (body mass index, BMI < 25 kg/m(2)). Patients in subgroup A were assumed to be GHD, whereas in patients belonging to subgroups B and C the presence of GHD had to be verified. Results: For the GHRH+ARG test, the best pair of highest sensitivity (Se; 100%) and specificity (Sp; 97%) was found choosing a peak GH of 19.0 mu g/l. For IGF-I levels, the best pair of highest Se (96.6%) and Sp (74.6%) was found using a cut-off point of 160 mu g/l(SDS: -1.3). Assuming 19.0 mu g/l to be the cut-off point established for GHRH+ARG test, 72.2%, of patients in subgroup B and 39.4% in subgroup C were defined as GHD. In patients belonging to group B and C and with a peak GH response < 19 mu g/l to the test, IGF-I levels were lower than 160 mu g/l (or less than 1.3 SDS) in 68.7 and 41.6% of patients respectively predicting severe GHD in 85.7% of panhypopituitary patients (subgroup A). Conclusions: In late adolescent and early adulthood patients, a GH cut-off limit using the GHRH+ARG test lower than 19.0 mu g/l is able to discriminate patients with a suspicion of GHD and does not vary from infancy to early adulthood.
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收藏
页码:701 / 708
页数:8
相关论文
共 37 条
[21]   TEST OF GROWTH-HORMONE SECRETION IN ADULTS - POOR REPRODUCIBILITY OF THE INSULIN TOLERANCE-TEST [J].
HOECK, HC ;
VESTERGAARD, P ;
JAKOBSEN, PE ;
LAURBERG, P .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 1995, 133 (03) :305-312
[22]   AGE AND RELATIVE ADIPOSITY ARE SPECIFIC NEGATIVE DETERMINANTS OF THE FREQUENCY AND AMPLITUDE OF GROWTH-HORMONE (GH) SECRETORY BURSTS AND THE HALF-LIFE OF ENDOGENOUS GH IN HEALTHY-MEN [J].
IRANMANESH, A ;
LIZARRALDE, G ;
VELDHUIS, JD .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1991, 73 (05) :1081-1088
[23]  
Israel E, 2000, J CLIN ENDOCR METAB, V85, P3990
[24]   Maximal secretory capacity of somatotrope cells in obesity: Comparison with GH deficiency [J].
Maccario, M ;
Valetto, MR ;
Savio, P ;
Aimaretti, G ;
Baffoni, C ;
Procopio, M ;
Grottoli, S ;
Oleandri, SE ;
Arvat, E ;
Ghigo, E .
INTERNATIONAL JOURNAL OF OBESITY, 1997, 21 (01) :27-32
[25]   Growth hormone (GH) deficiency (GHD) of childhood onset: Reassessment of GH status and evaluation of the predictive criteria for permanent GHD in young adults [J].
Maghnie, M ;
Strigazzi, C ;
Tinelli, C ;
Autelli, M ;
Cisternino, M ;
Loche, S ;
Severi, F .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1999, 84 (04) :1324-1328
[26]   Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement [J].
Maghnie, M ;
Aimaretti, G ;
Bellone, S ;
Bona, G ;
Bellone, J ;
Baldelli, R ;
de Sanctis, C ;
Gargantini, L ;
Gastaldi, R ;
Ghizzoni, L ;
Secco, A ;
Tinelli, C .
EUROPEAN JOURNAL OF ENDOCRINOLOGY, 2005, 152 (04) :589-596
[27]   GHRH plus arginine in the diagnosis of acquired GH deficiency of childhood-onset [J].
Maghnie, M ;
Cavigioli, F ;
Tinelli, C ;
Autelli, M ;
Aricò, M ;
Aimaretti, G ;
Ghigo, E .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2002, 87 (06) :2740-2744
[28]   Relationship between the morphological evaluation of the pituitary and the growth hormone (GH) response to GH-releasing hormone plus arginine in children and adults with congenital hypopituitarism [J].
Maghnie, M ;
Salati, B ;
Bianchi, S ;
Rallo, M ;
Tinelli, C ;
Autelli, M ;
Aimaretti, G ;
Ghigo, E .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2001, 86 (04) :1574-1579
[29]   Evaluation and treatment of adult growth hormone deficiency: An Endocrine Society clinical practice guideline [J].
Molitch, ME ;
Clemmons, DR ;
Malozowski, S ;
Merriam, GR ;
Shalet, SM ;
Vance, ML .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2006, 91 (05) :1621-1634
[30]   Influence of body mass index and gender on growth hormone (GH) responses to GH-releasing hormone plus arginine and insulin tolerance tests [J].
Qu, XD ;
Gonzalo, ITG ;
Al Sayed, MY ;
Cohan, P ;
Christenson, PD ;
Swerdloff, RS ;
Kelly, DF ;
Wang, C .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2005, 90 (03) :1563-1569