Diagnosis of Growth Hormone Deficiency in Children: The Efficacy of Glucagon versus Clonidine Stimulation Test

2021 ◽  
pp. 1-7
Author(s):  
Michal Yackobovitch-Gavan ◽  
Liora Lazar ◽  
Rotem Diamant ◽  
Moshe Phillip ◽  
Tal Oron
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Stimulation Test ◽  
Population Characteristics ◽  
Hormone Deficiency ◽  
Confirmatory Test ◽  
Diagnostic Efficacy ◽  
Provocative Test ◽  
Short Children ◽  
Confirmatory Tests

<b><i>Introduction:</i></b> The diagnosis of childhood growth hormone deficiency (GHD) requires a failure to respond to 2 GH stimulation tests (GHSTs) performed with different stimuli. The most commonly used tests are glucagon stimulation test (GST) and clonidine stimulation test (CST). This study assesses and compares GST and CST’s diagnostic efficacy for the initial evaluation of short children. <b><i>Methods:</i></b> Retrospective, single-center, observational study of 512 short children who underwent GHST with GST first or CST first and a confirmatory test with the opposite stimulus in cases of initial GH peak &#x3c;7.5 ng/mL during 2015–2018. The primary outcome measure was the efficacy of the GST first or CST first in diagnosing GHD. <b><i>Results:</i></b> Population characteristics include median age of 9.3 years (interquartile range 6.2, 12.1), 78.3% prepubertal, and 61% boys. Subnormal GH response in the initial test was recorded in 204 (39.8%) children: 148 (45.5%) in GST first and 56 (30%) in CST first, <i>p</i> &#x3c; 0.001. Confirmatory tests verified GHD in 75/512 (14.6%) patients. Divergent results between the initial and confirmatory tests were more prevalent in GST first than CST first (103/148 [69.6%] vs. 26/56 [46.4%], <i>p</i> &#x3c; 0.001) indicating a significantly lower error rate for the CST first compared to the GST first. In multivariate analysis, the only significant predictive variable for divergent results between the tests was the type of stimulation test (OR = 0.349 [95% CI 0.217, 0.562], <i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Screening of GH status with CST first is more efficient than that with GST first in diagnosing GHD in short children with suspected GHD. It is suggested that performing CST first may reduce the need for a second provocative test and avoid patients’ inconvenience of undergoing 2 serial tests.

scholarly journals Comparison of food intake and height increment in normal and constitutionally short children and in children with growth hormone deficiency.

1979 ◽  
Vol 26 (1) ◽  
pp. 133-136 ◽  
Author(s):  
YOSHIAKI OKADA ◽  
KAZUO WATANABE ◽  
TORU TAKEUCHI ◽  
TOSHIO ONISHI ◽  
KIYOJI TANAKA ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Food Intake ◽  
Growth Hormone Deficiency ◽  
Hormone Deficiency ◽  
Height Increment ◽  
Short Children

Prospective clinical trial of human growth hormone in short children without growth hormone deficiency

1984 ◽  
Vol 104 (2) ◽  
pp. 172-176 ◽  
Author(s):  
J.M. Gertner ◽  
M. Genel ◽  
S.P. Gianfredi ◽  
R.L. Hintz ◽  
R.G. Rosenfeld ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Human Growth Hormone ◽  
Human Growth ◽  
Prospective Clinical Trial ◽  
Hormone Deficiency ◽  
Short Children

The Role of Auxologic and Growth Factor Measurements in the Diagnosis of Growth Hormone Deficiency

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_3) ◽  
pp. 524-526
Author(s):  
Raymond L. Hintz
Keyword(s):  
Growth Hormone ◽  
Growth Factor ◽  
Growth Hormone Deficiency ◽  
Short Stature ◽  
The Body ◽  
Hormone Deficiency ◽  
Insulin Like Growth Factor ◽  
Growth Study ◽  
Short Children ◽  
National Cooperative

The use of auxologic measurements in the diagnosis of short stature in children has a long history in pediatric endocrinology, and they have even been used as the primary criteria in selecting children for growth hormone (GH) therapy. Certainly, an abnormality in the control of growth is more likely in short children than in children of normal stature. However, most studies have shown little or no value of auxologic criteria in differentiating short children who have classic growth hormone deficiency (GHD) from short children who do not. In National Cooperative Growth Study Substudy VI, in more than 6000 children being assessed for short stature, the overall mean height SD score was −2.5 ± 1.1 and the body mass index standard deviation score was −0.5 ± 1.4. However, there were no significant differences in these measures between the patients who were found subsequently to have GHD and those who were not. There also was no consistent difference in the growth rates between the patients with classic GHD and those short children without a diagnosis of GHD. This probably reflects the fact that we are dealing with a selected population of children who were referred for short stature and are further selecting those who are the shortest for additional investigation. Growth factor measurements have been somewhat more useful in selecting patients with GHD and have been proposed as primary diagnostic criteria. However, in National Cooperative Growth Study Substudy VI, only small differences in the levels of insulin-like growth factor I and insulin-like growth factor binding protein 3 were seen between the patients who were selected for GH treatment and those who were not. Many studies indicate that the primary value of growth factor measurements is to exclude patients who are unlikely to have GHD or to identify those patients in whom an expedited work-up should be performed. The diagnosis of GHD remains difficult and must be based on all of the data possible and the best judgment of an experienced clinician. Even under ideal circumstances, errors of both overdiagnosis and underdiagnosis of GHD still are likely.

Oral Clonidine Provocative Test in the Diagnosis of Growth Hormone Deficiency in Childhood: Should We Make the Timing Uniform?

2006 ◽  
Vol 66 (6) ◽  
pp. 285-288 ◽  
Author(s):  
Fiorella Galluzzi ◽  
Stefano Stagi ◽  
Maria Parpagnoli ◽  
Stefania Losi ◽  
Ilaria Pagnini ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Growth Hormone Deficiency ◽  
Hormone Deficiency ◽  
Provocative Test ◽  
Oral Clonidine
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