Results of early reevaluation of growth hormone secretion in short children with apparent growth hormone deficiency.
OBJECTIVE
To test the hypothesis that normalization of the growth hormone (GH) response to stimulation in patients with GH deficiency (GHD) and normal magnetic resonance imaging (MRI) of the hypothalamic-pituitary area might occur earlier than at attainment of final height.


METHODS
Prepubertal children with short stature (21 boys and 12 girls; age, 5.2-10 years), in whom a diagnosis of GHD was based on a GH response <10 microg/L after 2 pharmacologic tests (clonidine, arginine, or insulin hypoglycemia), and normal MRI of the hypothalamic-pituitary area were studied. After 1 to 6 months, all children underwent reevaluation of GH secretion by means of one of the provocative tests previously used. During that time, none of the children received GH therapy or entered puberty.


RESULTS
A GH response > or =10 microg/L after retesting was found in 28 patients, and a GH response <10 microg/L was found in 5. In 9 patients, the peak GH response at diagnosis was <7 microg/L to both tests used. In 8, the GH response at retesting was > or =10 microg/L and was 9.0 microg/L in the remaining child.


CONCLUSIONS
We suggest that patients with pathologic GH responses to provocative tests but normal MRI should be reevaluated and followed up before a diagnosis of GHD is firmly established.
Loche
Sandro
S
Servizio di Endocrinologia Pediatrica, Ospedale Regionale per le Microcitemie, Cagliari, Clinica Pediatrica, Servizio Analisi Chimico Cliniche, IRCCS Policlinico San Matteo, Università di Pavia, Italy.
Bizzarri
Carla
C
Maghnie
Mohamad
M
Faedda
Antonella
A
Tzialla
Chryssoula
C
Autelli
Michele
M
Casini
Maria Rosaria
MR
Cappa
Marco
M
D001827:Body Height / Q000502:physiology*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000503:physiopathology*; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency* / Q000378:metabolism*; D006801:Humans; D007031:Hypothalamus / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D010902:Pituitary Gland / Q000378:metabolism; D011237:Predictive Value of Tests; D013223:Statistics as Topic; D013997:Time Factors
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I