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IMPACT OF DIFFERENT CUT-OFF LIMITS OF PEAK GH AFTER GHRH-ARGININE STIMULATORY TEST, SINGLE IGF1 MEASUREMENT OR THEIR COMBINATION IN IDENTIFYING ADULT PATIENTS WITH GROWTH HORMONE DEFICIENCY.
MedLine Citation:
PMID:  21307143     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ObjectiveTo evaluate the impact of different peak GH cut-offs after GHRH-Arg, IGF1 or their combination in identifying GHD.Design and Patients894 controls(used for normative IGF1 levels) and 302 patients with suspected GHD. Different peak GH cut-off limits[used by European or North American(4.1 μg/l) Endocrine societies, by HypoCCs(2.5 μg/l), or with 95% specificity(based on BMI), Method 1, 2, 3 or 4, respectively] and IGF1 were considered.MethodsPeak GH after GHRH-Arg and IGF1. ResultsDifferent peak GH cut-offs recognized different proportions of GHD(range, 24.8%-62.9%).Methods with high sensitivity(1 and 2) recognized higher proportions(95.5% and 92.5%, respectively) of GHD among patients with three pituitary hormone deficits(TH), whereas,Method 4(with high specificity) identified 96.7% normal subjects among those without pituitary hormone deficits(HD); Method4 identified only 75%GHD among patients with TH, and Method 1 a high proportion(40%) of GHD among subjects without HD. 82% patients with TH and 84.5% without HD were recognized as GHD or normal, respectively by IGF1. Among the remaining patients with TH and normal IGF1, 75% was recognized as GHD by Method1; among patients without HD and abnormal IGF1, 87.5% was identified as normal by Method4. Overall, combination of IGF1 and Method1 or Method4 identified 95.5%GHD among patients with TH and 98.1% normal subjects among those without HD.ConclusionsSingle peak GH cut-offs have limits to sharply differentiate GHD from normal subjects; IGF1 may be used for selecting patients to be submitted to the GHRH-arg test; which peak GH cut-off limits should be used for identifying healthy or diseased patients depends mainly on the clinical context.
Authors:
Fausto Bogazzi; Luca Manetti; Martina Lombardi; Clara Giovannetti; Valentina Raffaelli; Claudio Urbani; Ilaria Scattina; Pasquale Pepe; Aldo Iannelli; Enio Martino; Giuseppe Rossi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-9
Journal Detail:
Title:  European journal of endocrinology / European Federation of Endocrine Societies     Volume:  -     ISSN:  1479-683X     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9423848     Medline TA:  Eur J Endocrinol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
F Bogazzi, Department of Endocrinology, University of Pisa, Pisa, 56124, Italy.
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