The pros and cons of sex steroid priming in growth hormone stimulation testing

Journal of pediatric endocrinology & metabolism: JPEM (Impact Factor: 1). 12/2012; 25(11-12):1049-1055. DOI: 10.1515/jpem.2011.327
Source: PubMed


Abstract Diagnosing growth hormone deficiency (GHD) remains a challenge, and the role of sex steroid priming in the diagnosis of GHD continues to be debated. This review examines existing data on sex steroid priming during GHD diagnosis. Primary literature was reviewed in the area of sex steroid priming and growth hormone stimulation tests. Studies supporting sex steroid priming suggest improved diagnostic efficiency with reduced false diagnosis of GHD in peripubertal children. Those that do not support sex steroid priming note the potential for underdiagnosis of GHD and the lack of standardization in sex steroid priming procedures. To date, there is no consensus on the use of sex steroid priming prior to performing growth hormone stimulation tests in the evaluation of GHD. A more targeted approach to using sex steroid priming may be reasonable; however, the decision of whether or not to use sex steroid priming should remain with the individual clinician.

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    ABSTRACT: There is still controversy for priming with sex steroid before growth hormone (GH) testing. Objective: We studied GH response to stimulation in 92 children >9 years with idiopathic short stature (height standard deviation score [HtSDS]-2). They were divided randomly into two groups. Children in Group 1 (n = 50) were primed with premarin in girls and testosterone in boys and those in Group 2 were not primed (n = 42). All children were tested using standard clonidine test and their serum insulin-like growth factor-I concentration (IGF-I). Additionally the growth and GH-IGF-I data of the two groups of children were compared with those for 32 short children (HtSDS <−2) below the age 9 years who were non-primed before GH testing (Group 3). Results: Neither GH peak response to provocation nor IGF-I concentrations differed between the two groups with and without priming. Discussion: Taking a cut-level of 7 ng/ml for normal GH response to clonidine, priming with sex steroids did not signifi cantly increase the percentage of patients with normal GH response (52%) versus nonpriming (47%). IGF-I level did not show any signifi cant difference among the two studied groups >9 years. The peak GH response to clonidine provocation test did not differ before (n = 42) versus after 9 years (n = 32) of age. Conclusions: In this randomized study priming with sex steroids before GH testing did not signifi cantly increase the yield of diagnosing short patients with normal GH secretion. In addition, GH response to provocation did not vary signifi cantly between young (<9 years) and old (>9 years) short children.
    11/2014; 18(1):80. DOI:10.4103/2230-8210.145078
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    ABSTRACT: Recombinant human GH (rhGH) has been available since 1985. This article gives an overview, what has been achieved over the past 30 years in respect to optimization of rhGH treatment for the individual child with GH deficiency and what are the safety issues concerned with this treatment. In the last twenty years significant scientific progress has been made in the diagnosis of GH deficiency, the genetic disorders that are associated with pituitary GH deficiency and the genetics that influence growth in general. On the other hand rhGH is not only used in states of GH deficiency but also various conditions without a proven GH deficiency by classical standards. Clinical studies that investigated both the genetics of growth and the individual responses to rhGH therapy in these patient populations were able to refine our concept about the physiology of normal growth. In most patients under rhGH treatment there is a considerable short-term effect, however the overall gain in growth obtained by a long-term treatment until final height still remains a matter of debate in some of the conditions treated. Also first studies on the long-term safety risks of rhGH treatment have raised the question whether this treatment is similarly safe for all the patient groups eligible for such a treatment. Therefore even in the face of a longstanding safety record of this drug replacement therapy the discussion about the right cost and risk to benefit ratio is continuing. Consequently there is still a need for carefully conducted long-term studies that use modern anthropometric, genetic, and laboratory techniques in order to provide the necessary information for clinicians to select the patients that will benefit best from this valuable treatment without any long term risk. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Best Practice & Research: Clinical Endocrinology & Metabolism 04/2015; 29(3). DOI:10.1016/j.beem.2015.04.009 · 4.60 Impact Factor