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dc.contributor.authorMurray, Robert D
dc.contributor.authorBidlingmaier, M
dc.contributor.authorStrasburger, Christian J
dc.contributor.authorShalet, Stephen M
dc.date.accessioned2009-06-30T14:06:10Z
dc.date.available2009-06-30T14:06:10Z
dc.date.issued2007-05
dc.identifier.citationThe diagnosis of partial growth hormone deficiency in adults with a putative insult to the hypothalamo-pituitary axis. 2007, 92 (5):1705-9 J. Clin. Endocrinol. Metab.en
dc.identifier.issn0021-972X
dc.identifier.pmid17327383
dc.identifier.doi10.1210/jc.2006-2055
dc.identifier.urihttp://hdl.handle.net/10541/71955
dc.description.abstractCONTEXT: 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 microg/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 microg/liter. IGF-I values for the GHI adults were significantly lower than the control subjects (121 +/- 48 vs. 162 +/- 75 microg/liter; P < 0.05); however, only six (26%) had values below the 10th percentile of levels seen in the control group. IGF binding protein-3 and acid labile subunit levels of the GHI adults were not significantly different from the controls. 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.
dc.language.isoenen
dc.subject.meshAdult
dc.subject.meshBody Mass Index
dc.subject.meshCarrier Proteins
dc.subject.meshCohort Studies
dc.subject.meshFemale
dc.subject.meshGlucose Tolerance Test
dc.subject.meshGlycoproteins
dc.subject.meshGrowth Hormone
dc.subject.meshHuman Growth Hormone
dc.subject.meshHumans
dc.subject.meshHypothalamic Diseases
dc.subject.meshHypothalamo-Hypophyseal System
dc.subject.meshInsulin
dc.subject.meshInsulin-Like Growth Factor Binding Protein 3
dc.subject.meshInsulin-Like Growth Factor I
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshPituitary Diseases
dc.subject.meshRadiotherapy
dc.subject.meshStimulation, Chemical
dc.titleThe diagnosis of partial growth hormone deficiency in adults with a putative insult to the hypothalamo-pituitary axis.en
dc.typeArticleen
dc.contributor.departmentDepartment of Endocrinology, Christie Hospital National Health Service Trust, Wilmslow Road, Manchester, United Kingdom.en
dc.identifier.journalThe Journal of Clinical Endocrinology and Metabolismen
html.description.abstractCONTEXT: 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 microg/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 microg/liter. IGF-I values for the GHI adults were significantly lower than the control subjects (121 +/- 48 vs. 162 +/- 75 microg/liter; P < 0.05); however, only six (26%) had values below the 10th percentile of levels seen in the control group. IGF binding protein-3 and acid labile subunit levels of the GHI adults were not significantly different from the controls. 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.


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