title: What is a normal stimulated growth hormone concentration?
abstract: In a retrospective analysis, we have compared the response of serum GH concentration to insulin-induced hypoglycaemia in 148 short prepubertal children (114 males, 34 females) aged between 3.9 and 11.9 years with the growth rate of the individual to determine 'cut-off' values for the diagnosis of GH insufficiency. Sixty-three children grew with a height velocity standard deviation score (SDS) greater than -0.8 (group 1), which represents the growth velocity of children progressing along or closely parallel to the third height centile. Eighty-five children had a height velocity SDS of less than -0.8 (group 2). Median peak serum GH concentration responses to insulin-induced hypoglycaemia were 19.9 mU/l (range 1.5-54.4) in group 1 and 9.9 mU/l (range 0.7-46.2) in group 2 (Mann-Whitney; P less than 0.001). Using growth rate as the determinant of normality, the efficiency, sensitivity and specificity of the insulin-induced hypoglycaemia test were calculated using different serum GH concentration cut-off values to diagnose GH insufficiency. In our (Hybritech) assay, a cut-off value of 13.5 mU/l provided optimal performance in terms of efficiency (66%), sensitivity (64%) and specificity (70%). The response of serum GH concentration to insulin-induced hypoglycaemia in short children growing at different growth rates was continuous. Each laboratory measuring serum GH concentrations needs to construct its own 'normal' cut-off value.
authors.affiliation: Endocrine Unit, Middlesex Hospital, London, U.K.
authors.forename: M T
authors.initials: MT
authors.lastname: Dattani
authors.forename: P J
authors.initials: PJ
authors.lastname: Pringle
authors.forename: P C
authors.initials: PC
authors.lastname: Hindmarsh
authors.forename: C G
authors.initials: CG
authors.lastname: Brook
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000097:blood; D013006:Growth Hormone / Q000097:blood* / Q000172:deficiency; D006801:Humans; D007003:Hypoglycemia / Q000097:blood; D015592:Immunoradiometric Assay; D008297:Male; D011627:Puberty / Q000097:blood; D012016:Reference Values; D012189:Retrospective Studies; D013268:Stimulation, Chemical
chemical_list: D013006:Growth Hormone