Clinical implications of residual growth hormone (GH) response to provocative testing in adults with severe GH deficiency.

2.50
Hdl Handle:
http://hdl.handle.net/10541/70042
Title:
Clinical implications of residual growth hormone (GH) response to provocative testing in adults with severe GH deficiency.
Authors:
Brabant, Georg E; Krogh Rasmussen, Ase; Biller, Beverly M K; Buchfelder, Michael; Feldt-Rasmussen, Ulla; Forssmann, Kristin; Jonsson, Bjorn; Koltowska-Häggström, Maria; Maiter, Dominique; Saller, Bernhard; Toogood, Andy
Abstract:
CONTEXT: The diagnosis of GH deficiency (GHD) in adults is based on provocative tests of GH release, all influenced by clinical factors. It is unknown whether the amount of residual GH reserve under the cutoff value has any physiological implication. OBJECTIVES: We used a large pharmacoepidemiological database of adult GHD (KIMS) and tested the impact of confounding factors on GH release of no greater than 3 microg/liter after an insulin tolerance test (ITT) and evaluated its potential physiological role. DESIGN, SETTINGS, AND PATIENTS: A total of 1098 patients fulfilled the criteria of having a GH peak of no greater than 3 microg/liter during ITT as well as documented IGF-I levels. OUTCOMES: The impact of underlying hypothalamic-pituitary disease, age, gender, body weight, as well as treatment modalities such as irradiation on peak GH level to ITT was evaluated, and the correlations between GH peak and targets of GH action were analyzed. RESULTS: The GH response to ITT was regulated by gender, age, and the number of additional pituitary deficiencies. In a multivariate evaluation, the extent of hypothalamic-pituitary dysfunction was the most important single predictor of GH peak in ITT. GH peaks in ITT were positively related to IGF-I levels and high-density lipoprotein-cholesterol, as well as inversely to triglycerides. CONCLUSIONS: Even in adult severe GHD, GH release appears to be regulated by factors defined to play an important role in normal GH secretion. The impact of very low GH release on IGF-I and lipid parameters indicates a persistent physiological role of low GH concentrations in severely affected patients with GHD.
Affiliation:
Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom. georg.brabant@manchester.ac.uk
Citation:
Clinical implications of residual growth hormone (GH) response to provocative testing in adults with severe GH deficiency. 2007, 92 (7):2604-9 J. Clin. Endocrinol. Metab.
Journal:
The Journal of Clinical Endocrinology and Metabolism
Issue Date:
Jul-2007
URI:
http://hdl.handle.net/10541/70042
DOI:
10.1210/jc.2007-0153
PubMed ID:
17488801
Type:
Article
Language:
en
ISSN:
0021-972X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorBrabant, Georg E-
dc.contributor.authorKrogh Rasmussen, Ase-
dc.contributor.authorBiller, Beverly M K-
dc.contributor.authorBuchfelder, Michael-
dc.contributor.authorFeldt-Rasmussen, Ulla-
dc.contributor.authorForssmann, Kristin-
dc.contributor.authorJonsson, Bjorn-
dc.contributor.authorKoltowska-Häggström, Maria-
dc.contributor.authorMaiter, Dominique-
dc.contributor.authorSaller, Bernhard-
dc.contributor.authorToogood, Andy-
dc.date.accessioned2009-06-09T16:45:16Z-
dc.date.available2009-06-09T16:45:16Z-
dc.date.issued2007-07-
dc.identifier.citationClinical implications of residual growth hormone (GH) response to provocative testing in adults with severe GH deficiency. 2007, 92 (7):2604-9 J. Clin. Endocrinol. Metab.en
dc.identifier.issn0021-972X-
dc.identifier.pmid17488801-
dc.identifier.doi10.1210/jc.2007-0153-
dc.identifier.urihttp://hdl.handle.net/10541/70042-
dc.description.abstractCONTEXT: The diagnosis of GH deficiency (GHD) in adults is based on provocative tests of GH release, all influenced by clinical factors. It is unknown whether the amount of residual GH reserve under the cutoff value has any physiological implication. OBJECTIVES: We used a large pharmacoepidemiological database of adult GHD (KIMS) and tested the impact of confounding factors on GH release of no greater than 3 microg/liter after an insulin tolerance test (ITT) and evaluated its potential physiological role. DESIGN, SETTINGS, AND PATIENTS: A total of 1098 patients fulfilled the criteria of having a GH peak of no greater than 3 microg/liter during ITT as well as documented IGF-I levels. OUTCOMES: The impact of underlying hypothalamic-pituitary disease, age, gender, body weight, as well as treatment modalities such as irradiation on peak GH level to ITT was evaluated, and the correlations between GH peak and targets of GH action were analyzed. RESULTS: The GH response to ITT was regulated by gender, age, and the number of additional pituitary deficiencies. In a multivariate evaluation, the extent of hypothalamic-pituitary dysfunction was the most important single predictor of GH peak in ITT. GH peaks in ITT were positively related to IGF-I levels and high-density lipoprotein-cholesterol, as well as inversely to triglycerides. CONCLUSIONS: Even in adult severe GHD, GH release appears to be regulated by factors defined to play an important role in normal GH secretion. The impact of very low GH release on IGF-I and lipid parameters indicates a persistent physiological role of low GH concentrations in severely affected patients with GHD.en
dc.language.isoenen
dc.subject.meshAdult-
dc.subject.meshDatabases, Factual-
dc.subject.meshFemale-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.subject.meshHypopituitarism-
dc.subject.meshInsulin-
dc.subject.meshInsulin Resistance-
dc.subject.meshInsulin-Like Growth Factor I-
dc.subject.meshLipid Metabolism-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshSeverity of Illness Index-
dc.titleClinical implications of residual growth hormone (GH) response to provocative testing in adults with severe GH deficiency.en
dc.typeArticleen
dc.contributor.departmentDepartment of Endocrinology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom. georg.brabant@manchester.ac.uken
dc.identifier.journalThe Journal of Clinical Endocrinology and Metabolismen

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