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.
    Full-text · Article · Nov 2014
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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.
    No preview · Article · Apr 2015 · Best Practice & Research: Clinical Endocrinology & Metabolism
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    ABSTRACT: To describe the growth, development and puberty in children with congenital IGHD before and during hGH treatment. Patients with cIGHD treated by hGH between the years 1958-1992. All patients were diagnosed, treated and followed in our clinic. Data were found in 37/41 patients (21 m, 16 f). 34 had hGH-1A deletions, 7 GHRH-R mutations. Patients, referred after age 25, were excluded. The birth length of 10/37 neonates was 48.29±2.26 (44-50) cm. Birth weight of 28/37 neonates was 3380±370g (m), 3230±409 g (f). Neuromotor milestones were variable. Age at referral was 5.7±4.2y (m) and 5.6±3.8y (f). Initiation of hGH treatment (35μg/kg/d) was 7.5±4.8, (0.8-15.08) y (m) and 6.8±4.36 (0.8-16.5)y (f). Height SDS increased from -4.3 to -1.8 (m) and from -4.5 to -2.6 (f). Head circumference increased from -2.6 to -1.3 (m) and from -2.7 to -2.3 (f). BMI increased from 15.8 to 20.6 (m) and from 15.5 to 20.4 (f). There was a negative correlation between age of hGH initiation and change in height SDS (r=-0.66; ρ<0.01), same for bone age (r=-0.69; ρ<0.01). Upper/lower body ratio decreased from 2.5±2.1 (m±SD) to 1.08±0.1 (ρ<0.0005). Puberty was delayed in boys, less so in girls. Mean age of 1st ejaculation (14m) was 17.6±2.2y and of menarche (14 f. was 13.7±1.2y. In both genders there was a positive correlation between age at start of hGH and age at onset of puberty (r=0.57; ρ<0.01). All reached full sexual development but the penile and testicular sizes were below normal. There was a positive correlation between length of hGH treatment and final testicular volume ( r=0.597, ρ=0.05) and a negative correlation between the age at initiation of hGH treatment and final testicular volume(r=-0.523, ρ=0.018). All were obese and hGH treatment increased the adiposity progressively (r=0.418, ρ=0.013). Early diagnosis and treatment of cIGHD enables normal or near normal growth, development and puberty. Copyright © 2015 Elsevier Ltd. All rights reserved.
    No preview · Article · May 2015 · Growth Hormone & IGF Research
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