Skip to main content
SpringerLink
Log in

The comparison of clonidine, arginine and both combined: a growth hormone stimulation test to differentiate multiple system atrophy from idiopathic Parkinson’s disease

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

This study was aimed at comparing the diagnostic accuracy of the growth hormone (GH) response to clonidine, arginine and both combined in order to establish a more reliable test to differentiate parkinsonism type multiple system atrophy (MSA-p) from Parkinson's disease (PD). Twenty-four patients with MSA-p and 26 cases with PD entered the study. They were submitted to treatments of clonidine, arginine and a combination of the two in a random manner on three different nonconsecutive days. The GH peak in serum at different times was evaluated and used as a primary variable for analysis of the stimulation test. By ROC analysis, we compared the sensitivity and specificity of tests of clonidine, arginine and both combined. After clonidine administration, the maximal average was significantly lower in patients with MSA-p than in those with PD (3.62 ± 0.81 vs. 6.91 ± 1.13; P < 0.05) with a sensitivity and specificity of 82.61 and 76.92%. After arginine administration, the maximal average GH concentration in serum at 30 min was also significantly lower in patients with MSA-p than in those with PD (4.07 ± 0.80 vs. 7.89 ± 1.29; P < 0.05) with a sensitivity and specificity of 78.26 and 73.08%. The sensitivity and specificity in differentiating MSA-p from PD was higher in the clonidine GH stimulation test than in the arginine GH stimulation test. However, when the clonidine and arginine were applied combined, the contrast of the maximal average GH concentration in serum in two groups was markedly increased (5.02 ± 1.12 vs. 10.75 ± 1.11; P < 0.05) with a sensitivity and specificity of 73.91 and 92.31%, and the specificity was notably increased in the combined GH stimulation test. Compared to the arginine GH stimulation test, the clonidine GH stimulation displayed a higher sensitivity and specificity; combined GH stimulation test of clonidine plus arginine could significantly enhance the specificity in differential diagnosis of MSA-p from PD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Barbiroli B, Martinelli P, Patuelli A, Lodi R, Iotti S, Cortelli P, Montagna P (1999) Phosphorus magnetic spectroscopy in multiple system atrophy and Parkinson’s disease. Mov Disord 14:430–435

    Article  CAS  PubMed  Google Scholar 

  2. Benarroch EE, Smithson IL, Low PA (1997) Depletion of catecholaminergic neurons of the rostral ventrolateral medulla in multiple system atrophy with autonomic failure. Ann Neurol 43:156–163

    Article  Google Scholar 

  3. Braune S, Reinhardt M, Schnitzer R, Riedel A, Lücking CH (1999) Cardiac uptake of 123I MIBG separates Parkinson’s disease from multiple system atrophy. Neurology 53:1020–1025

    CAS  PubMed  Google Scholar 

  4. Clarke CR, Ray PS, Speller JM (1993) Failure of the clonidine growth-hormone stimulation test to differentiate multiple-system atrophy from early or advanced idiopathic Parkinson’s disease. Lancet 53:1329–1330

    Google Scholar 

  5. Colosimo C, Albanese A, Hughes AJ, de Bruin VM, Lees AJ (1995) Some specific features differentiate MSA-P (striatonigral variety) from Parkinson’s disease. Arch Neurol 52:294–298

    CAS  PubMed  Google Scholar 

  6. Giustina A, Veldhuis JD (1998) Pathophysiology of the neuroregulation of growth hormone secretion in experimental animals and the human. Endocr Rev 19:717–797

    Article  CAS  PubMed  Google Scholar 

  7. Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson’s disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184

    Article  CAS  PubMed  Google Scholar 

  8. Kimber JR, Watson L, Mathias CJ (1997) Distinction of idiopathic Parkinson’s disease from multiple-system atrophy by stimulation of growth hormone release with clonidine. Lancet 349:1877–1881

    Article  CAS  PubMed  Google Scholar 

  9. Lee EA, Kim BJ, Lee WY (2002) Diagnosing multiple system atrophy with greater accuracy: combined analysis of the clonidine-growth hormone test and external anal sphincter electromyography. Mov Disord 17:1242–1247

    Article  PubMed  Google Scholar 

  10. Muller EE, Locatelli V, Cocchi D (1999) Neuroendocrine control of growth hormone secretion. Physiol Rev 79:511–607

    CAS  PubMed  Google Scholar 

  11. Palace J, Chandiramani VA, Fowler CJ (1997) Value of sphincter electromyography in the diagnosis of multiple system atrophy. Muscle Nerve 20:1396–1403

    Article  CAS  PubMed  Google Scholar 

  12. Pellecchia MT, Longo K, Manfredi M, Lucetti C, Cossu G, Petrone A, Marconi R, Sensi M, Epifanio A, Eleopra R, Marchese R, Scaravilli T, Morgante L, Abbruzzese G, Bonuccelli U, Donati E, Pivonello R, Colao A, Barone P (2008) The arginine growth hormone stimulation test in bradykinetic-rigid parkinsonisms. Mov Disord 23:190–194

    Article  PubMed  Google Scholar 

  13. Pellecchia MT, Pivonello R, Colao A, Barone P (2006) Growth hormone stimulation tests in the differential diagnosis of Parkinson’s disease. Clin Med Res 4:322–325

    Article  CAS  PubMed  Google Scholar 

  14. Pellecchia MT, Pivonello R, Salvatore E, Faggiano A, Barone P, De Michele G, Lombardi G, Colao A, Filla A (2005) Growth hormone response to arginine test distinguishes multiple system atrophy from Parkinson’s disease and idiopathic late-onset cerebellar ataxia. Clin Endocrinol 62:428–433

    Article  Google Scholar 

  15. Pirker W, Asenbaum S, Bencsits G, Prayer D, Gerschlager W, Deecke L, Brücke T (2000) [123I]beta-CIT SPECT in multiple system atrophy, progressive supranuclear palsy and corticobasal degeneration. Mov Disord 15:1158–1167

    Article  CAS  PubMed  Google Scholar 

  16. Quinn N (1994) Multiple system atrophy. In: Marsden CD, Fahn S (eds) Movement disorders, vol 3. Butterworth, London, pp 262–281

    Google Scholar 

  17. Schrag A, Good CD, Miszkiel K, Morris HR, Mathias CJ, Lees AJ, Quinn NP (2000) Differentiation of atypical parkinsonian syndromes with routine MRI. Neurology 54:697–702

    CAS  PubMed  Google Scholar 

  18. Spokes EGS, Bannister R, Oppenheimer DR (1979) Multiple system atrophy with autonomic failure. J Neurol Sci 43:69–82

    Article  Google Scholar 

  19. Strijks E, van’t Hof M, Sweep F, Lenders JW, Oyen WJ, Horstink MW (2002) Stimulation of growth-hormone release with clonidine does not distinguish individual cases of idiopathic Parkinson’s disease from those with striatonigral degeneration. J Neurol 249:1206–1210

    Article  CAS  PubMed  Google Scholar 

  20. Tranchant C, Guiraud-Chaumeil C, Echaniz-Laguna A, Warter JM (2000) Is clonidine growth hormone stimulation a good test to differentiate multiple atrophy from idiopathic Parkinson’s disease? J Neurol 247:853–856

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing, 210029, China

    Kezhong Zhang, Yanyin Zeng, Chunjie Song & Qi Wan

  2. Division of Nuclear Medicine, The First Affiliated Hospital of NJMU, Nanjing, 210029, China

    Yu Fu

Authors
  1. Kezhong Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanyin Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chunjie Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yu Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qi Wan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Qi Wan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, K., Zeng, Y., Song, C. et al. The comparison of clonidine, arginine and both combined: a growth hormone stimulation test to differentiate multiple system atrophy from idiopathic Parkinson’s disease. J Neurol 257, 1486–1491 (2010). https://doi.org/10.1007/s00415-010-5556-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-010-5556-x

Keywords

Search

Navigation