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Provocative growth hormone testing in children: how did we get here and where do we go now?

  • Camilia Kamoun , Colin Patrick Hawkes and Adda Grimberg EMAIL logo
Published/Copyright: April 12, 2021
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 34 Issue 6

Abstract

Objectives

Provocative growth hormone (GH) tests are widely used for diagnosing pediatric GH deficiency (GHD). A thorough understanding of the evidence behind commonly used interpretations and the limitations of these tests is important for improving clinical practice.

Content

To place current practice into a historical context, the supporting evidence behind the use of provocative GH tests is presented. By reviewing GH measurement techniques and examining the early data supporting the most common tests and later studies that compared provocative agents to establish reference ranges, the low sensitivity and specificity of these tests become readily apparent. Studies that assess the effects of patient factors, such as obesity and sex steroids, on GH testing further bring the appropriateness of commonly used cutoffs for diagnosing GHD into question.

Summary and Outlook

Despite the widely recognized poor performance of provocative GH tests in distinguishing GH sufficiency from deficiency, limited progress has been made in improving them. New diagnostic modalities are needed, but until they become available, clinicians can improve the clinical application of provocative GH tests by taking into account the multiple factors that influence their results.

Keywords: children; growth hormone assay; growth hormone deficiency; growth hormone stimulation tests; provocative growth hormone testing
Corresponding author: Adda Grimberg, MD, Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, 3500 Civic Center Blvd, 19104Philadelphia, PA, USA; and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Phone: +1 215 590 3618, Fax: +1 215 590 3053, E-mail:

Funding source: Pfizer

Award Identifier / Grant number: 2020 GH Research Competitive Grant Program Award

Funding source: National Institute of Diabetes and Digestive and Kidney Diseases

Award Identifier / Grant number: T32 DK063688

Funding source: Eunice Kennedy Shriver National Institute of Child Health and Human Development

Award Identifier / Grant number: R01 HD097129

  1. Research funding: C.K. was supported by NIH grant T32 DK063688 from the National Institute of Diabetes and Digestive and Kidney Diseases and A.G. by NIH grant R01 HD097129 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

  2. Author contributions: All the authors contributed to the writing of the manuscript. C.K. drafted the initial manuscript which was subsequently revised and improved by all the authors. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing Interests: C.K. and C.P.H. have no financial relationships relevant to this article to disclose. A.G. served as a Consultant for the Pediatric Endocrine Society Growth Hormone Deficiency Knowledge Center, sponsored by Sandoz, and was awarded an investigator-initiated competitive grant from Pfizer, Inc. The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Received: 2021-01-21
Accepted: 2021-03-08
Published Online: 2021-04-12
Published in Print: 2021-06-25

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Provocative growth hormone testing in children: how did we get here and where do we go now?
  4. Original Articles
  5. Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey
  6. Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children
  7. What is the relationship between obesity and new circadian rhythm parameters in Turkish children and adolescents? A case-control study
  8. Body fat distribution in trunk and legs are associated with cardiometabolic risk clustering among Chinese adolescents aged 10–18 years old
  9. Is overweight/obesity a risk factor for atopic allergic disease in prepubertal children? A case–control study
  10. Importance of individualizing treatment decisions in girls with central precocious puberty when initiating treatment after age 7 years or continuing beyond a chronological age of 10 years or a bone age of 12 years
  11. Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study
  12. Levels of physical activity and barriers to sport participation in young people with gender dysphoria
  13. Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity
  14. Validation of a continuous measure of cardiometabolic risk among adolescents
  15. Clinical characteristics and molecular genetic analysis of a cohort with idiopathic congenital hypogonadism
  16. The genetics and clinical manifestations of patients with vitamin D dependent rickets type 1A
  17. Switching from conventional therapy to burosumab injection has the potential to prevent nephrocalcinosis in patients with X-linked hypophosphatemic rickets
  18. Case Reports
  19. Asymptomatic pituitary apoplexy induced by corticotropin-releasing hormone in a 14 year-old girl with Cushing’s disease
  20. Two patients from Turkey with a novel variant in the GM2A gene and review of the literature
  21. Familial hyperphosphatemic tumoral calcinosis in an unusual and usual sites and dramatic improvement with the treatment of acetazolamide, sevelamer and topical sodium thiosulfate
  22. Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess
https://doi.org/10.1515/jpem-2021-0045
Keywords for this article
children; growth hormone assay; growth hormone deficiency; growth hormone stimulation tests; provocative growth hormone testing

Articles in the same Issue

  1. Frontmatter
  2. Review Article
  3. Provocative growth hormone testing in children: how did we get here and where do we go now?
  4. Original Articles
  5. Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey
  6. Prevalence of elevated liver enzymes and their association with type 2 diabetes risk factors in children
  7. What is the relationship between obesity and new circadian rhythm parameters in Turkish children and adolescents? A case-control study
  8. Body fat distribution in trunk and legs are associated with cardiometabolic risk clustering among Chinese adolescents aged 10–18 years old
  9. Is overweight/obesity a risk factor for atopic allergic disease in prepubertal children? A case–control study
  10. Importance of individualizing treatment decisions in girls with central precocious puberty when initiating treatment after age 7 years or continuing beyond a chronological age of 10 years or a bone age of 12 years
  11. Blood pressure dynamics after pubertal suppression with gonadotropin-releasing hormone analogs followed by estradiol treatment in transgender female adolescents: a pilot study
  12. Levels of physical activity and barriers to sport participation in young people with gender dysphoria
  13. Serum sclerostin concentration is associated with specific adipose, muscle and bone tissue markers in lean adolescent females with increased physical activity
  14. Validation of a continuous measure of cardiometabolic risk among adolescents
  15. Clinical characteristics and molecular genetic analysis of a cohort with idiopathic congenital hypogonadism
  16. The genetics and clinical manifestations of patients with vitamin D dependent rickets type 1A
  17. Switching from conventional therapy to burosumab injection has the potential to prevent nephrocalcinosis in patients with X-linked hypophosphatemic rickets
  18. Case Reports
  19. Asymptomatic pituitary apoplexy induced by corticotropin-releasing hormone in a 14 year-old girl with Cushing’s disease
  20. Two patients from Turkey with a novel variant in the GM2A gene and review of the literature
  21. Familial hyperphosphatemic tumoral calcinosis in an unusual and usual sites and dramatic improvement with the treatment of acetazolamide, sevelamer and topical sodium thiosulfate
  22. Pediatric diabetic ketoacidosis presenting with Streptococcus intermedius brain abscess
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