The Diagnosis of Partial Growth Hormone Deficiency in Adults with a Putative Insult to the Hypothalamo-Pituitary Axis

[~MaryO~]

http://jcem.endojournals.org/cgi/content/abstract/92/5/1705

 

 

Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2006-2055

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 5 1705-1709

Copyright ? 2007 by The Endocrine Society

 

The Diagnosis of Partial Growth Hormone Deficiency in Adults with a Putative Insult to the Hypothalamo-Pituitary Axis

 

Robert D. Murray, Martin Bidlingmaier, Christian J. Strasburger and Stephen M. Shalet

 

Department of Endocrinology (R.D.M., S.M.S.), Christie Hospital, Manchester M20 4BX, United Kingdom; St. James?s University Hospital (R.D.M.), Leeds LS9 7TF, United Kingdom; Medizinische Klinik-Innenstadt (M.B.), Ludwig-Maximilians Universitat, D-80336 Munich, Germany; and Charite Universitatsmedizin (C.J.S.), D-10117 Berlin, Germany

 

Address all correspondence and requests for reprints to: Professor S. M. Shalet, Department of Endocrinology, Christie Hospital National Health Service Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom. E-mail: stephen.m.shalet@man.ac.uk.

 

Context: Similar to patients with severe GH deficiency (GHD), those with a more moderate impairment of GH secretion [GH insufficiency (GHI)] have abnormal body composition, dyslipidemia, and insulin resistance. Given the inherent problems in the diagnosis of severe GHD, the situation is likely to be even more difficult in individuals with GHI.

 

Objective: The objective of the study was to examine the utility of GH stimulation tests and GH-dependent proteins in the diagnosis of GHI.

 

Design: The study was a cross-sectional, case-controlled study.

 

Patients: The study included 31 patients with GHD, 23 with GHI [peak GH 3?7 ?g/liter (9?21 mU/liter)], and 30 age- and sex-matched controls.

 

Main Outcome Measures: Demographic and biochemical markers of GH status were measured.

 

Results: Nineteen of the patients with GHI (83%) had no additional anterior pituitary hormone deficits. Ten GHI patients showed discordant GH status based on the two GH stimulation tests performed. GH status was defined by the highest peak GH value achieved; in four this was to the insulin tolerance test (ITT), four the arginine test, and two the GHRH-arginine test. In five of the six patients in whom GH status was not defined by the ITT, peak GH levels to the ITT were in the range 2.4?2.9 ?g/liter. IGF-I values for the GHI adults were significantly lower than the control subjects (121 ? 48 vs. 162 ? 75 ?g/liter; P

 

Conclusion: The diagnosis of GHI in an individual is extremely difficult because the patients rarely exhibit additional pituitary hormone deficits, and levels of GH-dependent proteins are normal in the majority. Diagnosis relies heavily on GH stimulation tests and requires two tests in all patients to define GHI; obesity when present is potentially a major confounder.

[MCF]

Mary, thank you for this and all the esoteric and informative citations you dig up!

 

Susan

[~MaryO~]

Mary, thank you for this and all the esoteric and informative citations you dig up!

 

Susan

I hope that some of them contain news that someone can use, either now or in the future!

[staticnrg]

Mary, I find this VERY interesting. Thank you!! (I also read everything you put in the research/news sections, but I don't always have time to post. )

Hugs!

Robin

[staticnrg]

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