دورية أكاديمية
أعرض في EDS

Diagnosis of Idiopathic GHD in Children Based on Response to rhGH Treatment: The Importance of GH Provocative Tests and IGF-1.

التفاصيل البيبلوغرافية
العنوان: Diagnosis of Idiopathic GHD in Children Based on Response to rhGH Treatment: The Importance of GH Provocative Tests and IGF-1.
المؤلفون: Felício JS; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Janaú LC; Department of Medicine, State University of Pará, Belém, Brazil., Moraes MA; Department of Medicine, State University of Pará, Belém, Brazil., Zahalan NA; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Souza Resende F; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Lemos MN; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Souza Neto NJK; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Farias de Franco II; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Leitão LTC; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Silva LSD; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Oliveira MCNI; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Alcântara AL; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Contente Braga de Souza AC; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., da Silva WM; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Dos Santos MC; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Queiroz NNM; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Moraes LV; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., de Figueiredo AB Jr; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Farinassi ALP; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Farias LMDC; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., da Silva DD; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Felício KM; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil., Abrahão Neto JF; Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil.
المصدر: Frontiers in endocrinology [Front Endocrinol (Lausanne)] 2019 Sep 19; Vol. 10, pp. 638. Date of Electronic Publication: 2019 Sep 19 (Print Publication: 2019).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Frontiers Research Foundation] Country of Publication: Switzerland NLM ID: 101555782 Publication Model: eCollection Cited Medium: Print ISSN: 1664-2392 (Print) Linking ISSN: 16642392 NLM ISO Abbreviation: Front Endocrinol (Lausanne) Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: [Lausanne : Frontiers Research Foundation]
مستخلص: Purpose: Serum IGF-1 (Insulin like growth factor 1) and Growth Hormone (GH) provocative tests are reasonable tools for screening and diagnosis of idiopathic GH Deficiency (IGHD). However, the average cut-off points applied on these tests have a lower level of evidence and produce large amounts of false results. The aim of this study is to evaluate the sensitivity, specificity, and accuracy of IGF-1 and GH stimulation tests as diagnostic tools for IGHD, using clinical response to recombinant human GH (rhGH) treatment as diagnostic standard [increase of at least 0.3 in height standard deviation (H-SD) in 1 year]. Methods: We performed a prospective study with 115 children and adolescents presenting short stature (SS), without secondary SS etiologies such as organic lesions, genetic syndromes, thyroid disorders. They were separated into Group 1 [patients with familial SS or constitutional delay of growth and puberty (CDGP), not treated with rhGH], Group 2 (patients with suspicion of IGHD with clinical response to rhGH treatment), and Group 3 (patients with suspicion of IGHD without growth response to rhGH treatment). Then, they were assessed for diagnostic performance of IGF-1, Insulin Tolerance Test (ITT) and clonidine test (CT) alone and combined at different cut-off points. Results: Based on the ROC curve, the best cut-off points found for IGF-1, ITT, and CT when they were used isolated were -0.492 SDS (sensitivity: 50%; specificity: 53.8%; accuracy: 46.5%), 4.515 μg/L (sensitivity: 75.5%; specificity: 45.5%; accuracy: 52.7%), and 4.095 μg/L (sensitivity: 54.5%; specificity: 52.6%; accuracy: 56.9%), respectively. When we had combined IGF-1 with-2SD as cut-off alongside ITT or CT, we found 7 μg/L as the best cut-off point. In this situation, ITT had sensitivity, specificity and accuracy of 93.9, 81.8, and 90.1%, while CT had 93.2, 68.4, and 85.7%, respectively. Conclusion: Our data suggest that diagnosis of IGHD should be established based on a combination of clinical expertise, auxologic, radiologic, and laboratorial data, using IGF-1 at the -2SD threshold combined, with ITT or CT at the cut-off point of 7 μg/L. Additional studies, similar to ours, are imperative to establish cut-off points based on therapeutic response to rhGH in IGHD, which would be directly related to a better treatment outcome.
(Copyright © 2019 Felício, Janaú, Moraes, Zahalan, de Souza Resende, de Lemos, de Souza Neto, Farias de Franco, Leitão, Silva, de Oliveira, de Alcântara, Contente Braga de Souza, da Silva, dos Santos, de Queiroz, de Moraes, de Figueiredo, Farinassi, Farias, da Silva, Felício and Abrahão Neto.)
References: Eur J Endocrinol. 2016 Jul;175(1):41-7. (PMID: 27147639)
J Clin Endocrinol Metab. 2008 Nov;93(11):4210-7. (PMID: 18782877)
Horm Res Paediatr. 2018;90(1):44-53. (PMID: 30110706)
Med Sci Monit. 2009 Jan;15(1):MT5-10. (PMID: 19114977)
Curr Opin Pediatr. 2017 Aug;29(4):466-471. (PMID: 28525404)
Growth Horm IGF Res. 2019 Feb;44:20-32. (PMID: 30605792)
Arq Bras Endocrinol Metabol. 2008 Jul;52(5):734-44. (PMID: 18797579)
J Clin Endocrinol Metab. 2008 Nov;93(11):4342-50. (PMID: 18728172)
Horm Res Paediatr. 2013;79(2):51-67. (PMID: 23446062)
JAMA. 2014 May 7;311(17):1787-96. (PMID: 24794372)
Clinics (Sao Paulo). 2016 Apr;71(4):226-31. (PMID: 27166774)
Arch Dis Child. 1969 Jun;44(235):291-303. (PMID: 5785179)
Inhal Toxicol. 2014 Nov;26(13):811-28. (PMID: 25264934)
Acta Paediatr Suppl. 2006 Apr;450:76-85. (PMID: 16817681)
Nat Rev Endocrinol. 2018 May;14(5):285-300. (PMID: 29546874)
Horm Res Paediatr. 2011;76 Suppl 3:56-8. (PMID: 21912170)
Ann Endocrinol (Paris). 2007 Dec;68(6):449-55. (PMID: 17991453)
J Clin Endocrinol Metab. 2005 Sep;90(9):5247-53. (PMID: 15998780)
Horm Res. 2002;58(5):233-41. (PMID: 12401943)
J Clin Res Pediatr Endocrinol. 2017 Dec 30;9(Suppl 2):23-32. (PMID: 29280742)
Ann Endocrinol (Paris). 2017 Jun;78(2):106-107. (PMID: 28457480)
J Paediatr Child Health. 2013 Mar;49(3):165-9. (PMID: 22582941)
Clin Endocrinol (Oxf). 2018 Dec;89(6):765-770. (PMID: 30171702)
Horm Res. 2003;59(5):229-33. (PMID: 12714786)
Endocr Regul. 2006 Sep;40(3):69-75. (PMID: 17100548)
Indian J Endocrinol Metab. 2014 Nov;18(Suppl 1):S80-3. (PMID: 25538882)
J Clin Endocrinol Metab. 2008 Feb;93(2):352-7. (PMID: 18000092)
Horm Res. 2001;55(3):115-24. (PMID: 11549872)
J Pediatr Endocrinol Metab. 2012;25(11-12):1049-55. (PMID: 23329747)
J Endocrinol Invest. 2018 Aug;41(8):977-983. (PMID: 29423542)
Eur J Pediatr. 2015 Apr;174(4):419-27. (PMID: 25213432)
J Pediatr. 1978 Nov;93(5):749-55. (PMID: 712475)
J Pediatr. 1952 Apr;40(4):423-41. (PMID: 14918032)
Arch Dis Child. 1970 Feb;45(239):13-23. (PMID: 5440182)
J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):40-5. (PMID: 20929010)
Best Pract Res Clin Endocrinol Metab. 2016 Dec;30(6):737-747. (PMID: 27974187)
Clin Chem Lab Med. 2004;42(6):654-64. (PMID: 15259383)
Eur J Endocrinol. 2014 Sep;171(3):389-97. (PMID: 24966174)
J Clin Endocrinol Metab. 1994 Aug;79(2):537-41. (PMID: 8045974)
Int J Pediatr Endocrinol. 2014;2014(1):15. (PMID: 25075207)
Pediatr Endocrinol Rev. 2011 Sep;9 Suppl 1:535-7. (PMID: 22423512)
Endocr Connect. 2018 Jun;7(6):R212-R222. (PMID: 29724795)
Horm Res Paediatr. 2016;86(6):361-397. (PMID: 27884013)
Ther Adv Endocrinol Metab. 2017 May;8(5):75-80. (PMID: 28634534)
Arch Dis Child. 2016 Jan;101(1):96-100. (PMID: 26153506)
فهرسة مساهمة: Keywords: IGF-1; IGHD; clonidine test; growth hormone deficiency; insulin tolerance test
تواريخ الأحداث: Date Created: 20191017 Latest Revision: 20191023
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC6763693
DOI: 10.3389/fendo.2019.00638
PMID: 31616374
قاعدة البيانات: MEDLINE
الوصف
تدمد:1664-2392
DOI:10.3389/fendo.2019.00638