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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.
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
html.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.


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