The arginine stimulation test: timing of peak is not a helpful parameter in the diagnosis of growth hormone deficiency
-
David Gillis
,
Nadav Granat
Abstract
Background: A typical peak timing in the glucagon stimulation test has been reported as an indication of growth hormone (GH) deficiency. Other stimulation tests have not been evaluated.
Objective: To evaluate the clinical usefulness of peak timing in the arginine stimulation test (AST) for growth hormone deficiency.
Methods: Retrospective review of 199 ASTs from one center. Outcomes included correlation of peak times with (a) frequency of deficient peak; (b) growth velocity standard deviation scores (GVSDSs); (c) other evidence of pituitary pathology; (d) results of confirmatory clonidine test; and (e) response to GH treatment.
Results: The peak in 83/109 (76.14%) sufficient tests occurred at typical times vs. 45/72 (62.5%) deficient tests (p<0.05). GVSDS on GH treatment was greater among patients with typical timing in the AST compared with atypical timing (2.67±0.59 vs. 0.46±1.17, p=0.021). No other variable correlated significantly with AST timing.
Conclusions: Timing of peak in the AST is not a clinically useful parameter.
References
1. Ranke MB. Diagnosis of growth hormone deficiency and growth hormone stimulation tests. In: Ranke MB, editor. Diagnostic of endocrine function in children and adolescents, 3rd ed. Basel: Karger, 2003:107–28.Search in Google Scholar
2. Israel Association of Pediatric Endocrinology Committee on Growth Hormone Diagnosis and Treatment. Clinical guidelines; diagnosis and management of growth hormone deficiency. Tel Aviv: Israel Medical Association Publications, 1999:1–10.Search in Google Scholar
3. Muster L, Zangen DH, Nesher R, Hirsch HJ, Muster Z, et al. Arginine and clonidine stimulation tests for growth hormone deficiency revisited; do we really need so many samples? J Pediatr Endocrinol Metab 2009;22:215–23.10.1515/JPEM.2009.22.3.215Search in Google Scholar
4. Merimme T, Lillicrap DA. Rabinowits D. Effect of arginine on serum levels of human growth-hormone. Lancet 1965;7414:668–70.10.1016/S0140-6736(65)90399-5Search in Google Scholar
5. Parker ML, Hammond JM, Daughaday WH. The arginine provocative test: an aid in the diagnosis of hyposomatropism. J Clin Endocrinol 1967;27:1129–36.10.1210/jcem-27-8-1129Search in Google Scholar PubMed
6. Strich D, Terespolsky N, Gillis D. Glucagon stimulation test for childhood growth hormone deficiency: timing of the peak is important. J Pediatr 2009;154:415–9.10.1016/j.jpeds.2008.08.044Search in Google Scholar PubMed
7. Trainer PJ, Barth J, Sturgeon C, Wieringaon G. Consensus statement on the standardization of GH assays. Eur J Endocrinol 2006;155:1–2.10.1530/eje.1.02186Search in Google Scholar PubMed
8. Eliakim A, Brasel JA, Cooper DM. GH response to exercise: assessment of the pituitary refractory period, and relationship with circulating components of the GH-IGF-I axis in adolescent females. J Pediatr Endocrinol Metab 1999;12:47–55.10.1515/JPEM.1999.12.1.47Search in Google Scholar
9. Svensson J, Johannsson G, Iranmanesh A, Albertsson-Wikland K, Veldhuis JD, et al. GH secretory pattern in young adults who discontinued GH treatment for GH deficiency and decreased longitudinal growth in childhood. Eur J Endocrinol 2006;155:91–9.10.1530/eje.1.02182Search in Google Scholar PubMed
10. Svensson J, Veldhuis JD, Iranmanesh A, Bengtsson BA, Johannsson G. Increased orderliness of growth hormone (GH) secretion in GH-deficient adults with low serum insulin-like growth factor I. J Clin Endocrinol Metab 2002;87:2863–9.10.1210/jcem.87.6.8566Search in Google Scholar PubMed
11. Zeniou-Meyer M, Zabari N, Ashery U, Chasserot-Golaz S, Haeberlé AM, et al. Phospholipase D1 production of phosphatidic acid at the plasma membrane promotes exocytosis of large dense-core granules at a late stage. J Biol Chem 2007;282:21746–57.10.1074/jbc.M702968200Search in Google Scholar PubMed
12. Rogol A, Blethen SL, Sy J, Veldhuist. Do growth hormone (GH) serial sampling, insulin-like growth factor-1 (IGF-1) or auxological measurements have an advantage over GH stimulation testing in predicting the linear growth response to GH therapy? Clin Endocrinol 2003;58:229–337.10.1046/j.1365-2265.2003.01701.xSearch in Google Scholar PubMed
©2013 by Walter de Gruyter Berlin Boston
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Articles in the same Issue
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- Images in pediatric endocrinology
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- Genetic diagnosis of one family with incomplete clinical data
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