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Growth hormone deficiency in children

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Abstract

The foundation for the diagnosis of growth hormone (GH) deficiency in childhood must be auxology, that is, the comparison of the child’s growth pattern to that of established norms for gender and ethnicity. It is only in those growing considerably more slowly than average that testing for GHD makes sense. Assessment of laboratory tests, whether static, for example, the measurement of growth factors or their binding proteins, or dynamic, for example, secretagogue-stimulated GH secretion is confirmatory. One must be cognizant of the assay used to determine GH, for there may be a 3-fold difference in the concentration of GH among commercially-available assays. Controversy still exists concerning the measurement of spontaneous GH release and whether sex-steroid priming is appropriate in prepubertal children. Imaging analysis may prove helpful in some children with congenital GHD or to detect a space-occupying lesion in the area of the hypothalamus and pituitary. The final diagnosis is based on multiple parameters and occasionally on a therapeutic trial of GH therapy to determine if there is a significant acceleration of growth velocity.

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References

  1. Ranke MB, Schweizer R, Lindberg A et al (2004) Insulin-like growth factors as diagnostic tools in growth hormone deficiency during childhood and adolescence: the KIGS experience. Horm Res 62:17–25. doi:10.1159/000080754

    Article  PubMed  CAS  Google Scholar 

  2. Jensen RB, Jeppesen KA, Vielwerth S et al (2005) Insulin-like growth factor I (IGF-I) and IGF-binding protein 3 as diagnostic markers of growth hormone deficiency in infancy. Horm Res 63:15–21. doi:10.1159/000082456

    Article  PubMed  CAS  Google Scholar 

  3. Strasburger CJ, Bidlingmaier M (2005) How robust are laboratory measures of growth hormone status? Horm Res 64:1–5. doi:10.1159/000087745

    Article  PubMed  CAS  Google Scholar 

  4. Hasegawa Y, Hasegawa T, Aso T et al (1992) Usefulness and limitation of measurement of insulin-like growth factor binding protein-3 (IGFBP-3) for diagnosis of growth hormone deficiency. Eur J Endocrinol 39:585–591

    CAS  Google Scholar 

  5. Smith WJ, Underwood LE, Busby WH et al (1993) Use of insulin-like growth factor-binding protein-2 (IGFBP-2), IGFBP-3, and IGF-I for assessing growth hormone status in short children. J Clin Endocrinol Metab 77:1294–1299. doi:10.1210/jc.77.5.1294

    Article  PubMed  CAS  Google Scholar 

  6. Bidlingmaier M, Strasburger CJ (2007) Growth hormone assays: current methodologies and their limitations. Pituitary 10:115–119. doi:10.1007/s11102-007-0030-1

    Article  PubMed  CAS  Google Scholar 

  7. Wieringa GE, Trainer PJ (2007) Commentary: harmonizing growth hormone measurements: learning lessons for the future. J Clin Endocrinol Metab 92:2874–2875. doi:10.1210/jc.2007-0750

    Article  PubMed  CAS  Google Scholar 

  8. Fass B, Lippe BM, Kaplan SA (1979) Relative usefulness of three growth hormone stimulation screening tests. Am J Dis Child 133:931–933

    PubMed  CAS  Google Scholar 

  9. Guyda HJ (2000) Growth hormone testing and the short child. Pediatr Res 48:579–580. doi:10.1203/00006450-200011000-00003

    Article  PubMed  CAS  Google Scholar 

  10. Gandrud LM, Wilson DM (2004) Is growth hormone stimulation testing in children still appropriate? Growth Horm IGF Res 14:185–194. doi:10.1016/j.ghir.2003.11.003

    Article  PubMed  Google Scholar 

  11. Ghigo E, Bellone J, Aimaretti G et al (1996) Reliability of provocative tests to assess growth hormone secretory status. Study in 472 normally growing children. J Clin Endocrinol Metab 81:3323–3327. doi:10.1210/jc.81.9.3323

    Google Scholar 

  12. Growth Hormone Research Society (2000) Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH research society. GH research society. J Clin Endocrinol Metab 85:3990–3993. doi:10.1210/jc.85.11.3990

    Article  Google Scholar 

  13. Alba-Roth J, Muller OA, Schopohl J et al (1988) Arginine stimulates growth hormone secretion by suppressing endogenous somatostatin secretion. J Clin Endocrinol Metab 67:1186–1189

    PubMed  CAS  Google Scholar 

  14. Root AW, Saenz-Rodriguez C, Bongiovanni AM et al (1969) The effect of arginine infusion on plasma growth hormone and insulin in children. J Pediatr 74:187–197. doi:10.1016/S0022-3476(69)80066-1

    Article  PubMed  CAS  Google Scholar 

  15. Merimee TJ, Rabinowitz D, Fineberg SE (1969) Arginine-initiated release of human growth hormone. Factors modifying the response in normal man. N Engl J Med 280:1434–1438

    PubMed  CAS  Google Scholar 

  16. Mauras N, Walton P, Nicar M et al (2000) Growth hormone stimulation testing in both short and normal statured children: use of an immunofunctional assay. Pediatr Res 48:614–618. doi:10.1203/00006450-200011000-00010

    Article  PubMed  CAS  Google Scholar 

  17. Weldon VV, Gupta SK, Haymond MW et al (1973) The use of L-DOPA in the diagnosis of hyposomatotropism in children. J Clin Endocrinol Metab 36:42–46

    PubMed  CAS  Google Scholar 

  18. Weldon VV, Gupta SK, Klingensmith et al (1975) Evaluation of growth hormone release in children using arginine and L-dopa in combination. J Pediatr 87:540–544. doi:10.1016/S0022-3476(75)80816-X

    Article  PubMed  CAS  Google Scholar 

  19. Philippi H, Pohlenz J, Grimm W et al (2000) Simultaneous stimulation of growth hormone, adrenocorticotropin and cortisol with L-dopa/L-carbidopa and propranolol in children of short stature. Acta Paediatr 89:442–446. doi:10.1080/080352500750028168

    Article  PubMed  CAS  Google Scholar 

  20. Collu R, Brun G, Milsant F et al (1978) Reevaluation of levodopa-propranolol as a test of growth hormone reserve in children. Pediatrics 61:242–244

    PubMed  CAS  Google Scholar 

  21. Reiter EO, Martha PM (1990) Pharmacological testing of growth hormone secretion. Horm Res 33:121–126

    PubMed  CAS  Google Scholar 

  22. Lanes R, Hurtado E (1982) Oral clonidine-an effective growth hormone-releasing agent in prepubertal subjects. J Pediatr 100:710–714. doi:10.1016/S0022-3476(82)80569-6

    Article  PubMed  CAS  Google Scholar 

  23. Huang C, Banerjee K, Sochett E et al (2001) Hypoglycemia associated with clonidine testing for growth hormone deficiency. J Pediatr 139:323–324. doi:10.1067/mpd.2001.116276

    Article  PubMed  CAS  Google Scholar 

  24. Lanes R, Recker B, Fort P (1985) Low-dose oral clonidine. A simple and reliable growth hormone screening test for children. Am J Dis Child 139:87–88

    PubMed  CAS  Google Scholar 

  25. Fraser NC, Seth J, Brown NS (1983) Clonidine is a better test for growth hormone deficiency than insulin hypoglycaemia. Arch Dis Child 58:355–358

    PubMed  CAS  Google Scholar 

  26. Takano K, Hizuka N, Asakawa K et al (1984) Plasma growth hormone (GH) response to GH-releasing factor in normal children with short stature and patients with pituitary dwarfism. J Clin Endocrinol Metab 58:236–241

    Article  PubMed  CAS  Google Scholar 

  27. Butenandt O (1989) Diagnostic value of growth hormone-releasing hormone tests in short children. Acta Paediatr Scand 349:93–99

    Article  CAS  Google Scholar 

  28. Martha PM, Blizzard RM, McDonald JA et al (1988) A persistent pattern of varying pituitary responsivity to exogenous growth hormone (GH)-releasing hormone in GH-deficient children: evidence supporting periodic somatostatin secretion. J Clin Endocrinol Metab 67:449–454

    PubMed  CAS  Google Scholar 

  29. Maghnie M, Salati B, Bianchi S et al (2001) Relationship between the morphological evaluation of the pituitary and the growth hormone (GH) response to GH-releasing hormone plus arginine in children and adults with congenital hypopituitarism. J Clin Endocrinol Metab 86:1574–1579. doi:10.1210/jc.86.4.1574

    Article  PubMed  CAS  Google Scholar 

  30. Ghigo E, Bellone J, Aimaretti G et al (1996) Reliability of provocative tests to assess growth hormone secretory status. Study in 472 normally growing children. J Clin Endocrinol Metab 81:3323–3327. doi:10.1210/jc.81.9.3323

    Article  PubMed  CAS  Google Scholar 

  31. Ham JN, Ginsberg JP, Hendell CD et al (2005) Growth hormone releasing hormone plus arginine stimulation testing in young adults treated in childhood with cranio-spinal radiation therapy. Clin Endocrinol (Oxf) 62:628–632. doi:10.1111/j.1365–2265.2005.02272.x

    Article  CAS  Google Scholar 

  32. Maghnie M, Cavigioli F, Tinelli C et al (2002) GHRH plus arginine in the diagnosis of acquired GH deficiency of childhood-onset. J Clin Endocrinol Metab 87:2740–2744. doi:10.1210/jc.87.6.2740

    Article  PubMed  CAS  Google Scholar 

  33. Leong KS, Walker AB, Martin I et al (2001) An audit of 500 subcutaneous glucagon stimulation tests to assess growth hormone and ACTH secretion in patients with hypothalamic-pituitary disease. Clin Endocrinol (Oxf) 54:463–468. doi:10.1046/j.1365-2265.2001.01169.x

    Article  CAS  Google Scholar 

  34. Mitchell ML, Sawin CT (1972) Growth hormone response to glucagon in diabetic and nondiabetic persons. Isr J Med Sci 8:867

    PubMed  CAS  Google Scholar 

  35. Collu R, Leboeuf G, Letarte J et al (1975) Stimulation of growth hormone secretion by levodopa-propranolol in children and adolescents. Pediatrics 56:262–266

    Google Scholar 

  36. Schonberger W, Ziegler R, Brodt B et al (1976) GH secretion after oral application of L-dopa and L-carbidopa. Eur J Pediatr 122:195–200. doi:10.1007/BF00463737

    Article  PubMed  CAS  Google Scholar 

  37. Shah A, Stanhope R, Mathew D (1991) Hazards of pharmacological tests of growth hormone secretion in childhood. BMJ 304:173–174

    Google Scholar 

  38. Kaplan SL, Abrams CA, Bell JJ et al (1968) Growth and growth hormone. I. Changes in serum level of growth hormone following hypoglycemia in 134 children with growth retardation. Pediatr Res 2:43–63. doi:10.1203/00006450-196801000-00005

    Article  PubMed  CAS  Google Scholar 

  39. Root AW, Rosenfield RL, Bongiovanni AM et al (1967) The plasma growth hormone response to insulin-induced hypoglycemia in children with retardation of growth. Pediatrics 39:844–852

    PubMed  CAS  Google Scholar 

  40. Gonc EN, Yordam N, Kandemir N et al (2001) Comparison of stimulated growth hormone levels in primed versus unprimed provocative tests. Effect of various testosterone doses on growth hormone levels. Horm Res 56:32–37. doi:10.1159/000048087

    Article  PubMed  CAS  Google Scholar 

  41. Couto-Silva AC, Trivin C, Adan L et al (2005) Management of boys with short stature and delayed puberty. J Pediatr Endocrinol Metab 18:807–813

    PubMed  CAS  Google Scholar 

  42. Martinez AS, Domene HM, Ropelato MG et al (2000) Estrogen priming effect on growth hormone (GH) provocative test: a useful tool for the diagnosis of GH deficiency. J Clin Endocrinol Metab 85:4168–4172. doi:10.1210/jc.85.11.4168

    Article  PubMed  CAS  Google Scholar 

  43. Marin G, Domene HM, Barnes KM et al (1994) The effects of estrogen priming and puberty on the growth hormone response to standardized treadmill exercise and arginine-insulin in normal girls and boys. J Clin Endocrinol Metab 79:537–541

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Pediatric Endocrinology, National Children´s Hospital, San Jose, Costa Rica

    Erick J. Richmond

  2. School of Medicine, Pediatrics and Pediatric Endocrinology, University of Costa Rica, San Jose, Costa Rica

    Erick J. Richmond

  3. Pediatric Endocrinology, University of Virginia, 685 Explorers Road, Charlottesville, VA, 22911-8441, USA

    Alan D. Rogol

  4. Riley Hospital, Indiana University School of Medicine, Indianapolis, IN, USA

    Alan D. Rogol

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  1. Erick J. Richmond
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  2. Alan D. Rogol
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Correspondence to Alan D. Rogol.

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Richmond, E.J., Rogol, A.D. Growth hormone deficiency in children. Pituitary 11, 115–120 (2008). https://doi.org/10.1007/s11102-008-0105-7

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