Abstract:
CONTEXT:Adult growth hormone (GH) deficiency (GHD) is diagnosed by provocative testing of GH secretion. OBJECTIVE:To improve the diagnostic accuracy of GH-releasing hormone (GHRH) plus arginine (GARG) testing, we evaluated the influence of age, BMI and sex and established normative data for an automatic immunoassay specifically measuring 22 kDa human GH. DESIGN/SETTING:Prospective multicenter study. PARTICIPANTS:Eighty-seven patients with hypothalamic-pituitary disease and 200 healthy controls. Patients were classified according to the number of pituitary hormone deficiencies (PHD). GHD was assumed when ≥2 PHD (in addition to GH) were present (n = 51); 36 patients with <2 PHD were considered GH sufficient (GHS). ROC analysis identified cutoffs with ≥95% specificity for GHD. Controls were prospectively stratified for sex, age and BMI. INTERVENTIONS:All participants received GHRH and l-arginine. MAIN OUTCOME MEASURES:GH was measured by immunoassay (iSYS, IDS). RESULTS:In controls, multiple stepwise regression analysis showed that BMI (21%, P < 0.0001), sex (20%, P < 0.0001) and age (5%, P < 0.001), accounted for 46% of GH peak level variability during GARG. Comparison of peak GH during GARG (GHD vs GHS + controls) revealed an overall cutoff of 3.9 ng/mL (sensitivity 86%, specificity 95%). After adjustment for BMI and sex, optimal cutoffs (male vs female) were 6.5 vs 9.7 ng/mL in lean, 3.5 vs 8.5 ng/mL in overweight and 2.2 vs 4.4 ng/mL in obese subjects respectively. CONCLUSION:BMI and sex account for most of the variability of peak GH levels during GARG. Consequently, diagnostic accuracy of the GARG test is significantly improved by use of adjusted cutoffs.
journal_name
Eur J Endocrinoljournal_title
European journal of endocrinologyauthors
Deutschbein T,Bidlingmaier M,Schopohl J,Strasburger CJ,Petersenn Sdoi
10.1530/EJE-16-0668subject
Has Abstractpub_date
2017-03-01 00:00:00pages
273-281issue
3eissn
0804-4643issn
1479-683Xpii
EJE160668journal_volume
176pub_type
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