title: Growth hormone response to arginine test distinguishes multiple system atrophy from Parkinson's disease and idiopathic late-onset cerebellar ataxia.
abstract: OBJECTIVE
  Multiple system atrophy (MSA) is difficult to distinguish from idiopathic Parkinson's disease (PD) and idiopathic late-onset cerebellar ataxia (ILOCA). This study aimed to evaluate GH response to three different GH stimulation tests in order to establish a reliable test to differentiate these degenerative disorders.
  
  
  METHODS
  Twelve patients with MSA, 10 with PD, eight with ILOCA and 30 healthy controls entered the study. They were submitted to clonidine, arginine, and GH-releasing-hormone (GHRH) + arginine tests in a random manner on three different nonconsecutive days. The peak serum GH response was used as a primary variable for analysis of stimulation tests. By ROC analysis, the optimum cut-off level was considered as the cut-off with the maximal sum of sensitivity and specificity.
  
  
  RESULTS
  After clonidine administration, GH peak was significantly lower in patients with MSA than in those with ILOCA (P < 0.05) and in the controls (P < 0.001). At the optimum cut-off level of 5 mU/l, the clonidine test distinguished patients with MSA from those with PD with a sensitivity and specificity of 78%. Moreover, this test distinguished patients with MSA from those with ILOCA with a sensitivity of 100% and a specificity of 75% at a cut-off level of 5 mU/l, and with a sensitivity of 75% and a specificity of 100% at the cut-off level of 7.6 mU/l. After arginine administration, the GH peak was significantly lower in patients with MSA than in those with ILOCA (P = 0.001) and in controls (P < 0.001). At the optimum cut-off level of 5 mU/l, the arginine test distinguished patients with MSA from those with PD with a sensitivity and a specificity of 100%. At a GH peak cut-off value of 3.6 mU/l the arginine test distinguished patients with MSA from those with ILOCA with a sensitivity and specificity of 100%. After GHRH + arginine administration, a significant GH increase was found in all groups of patients and controls.
  
  
  CONCLUSIONS
  The GH response to arginine administration is impaired in MSA. Therefore, the arginine test showed the highest diagnostic accuracy to distinguish MSA from both PD and ILOCA, and could be used in the clinical practice of these neurodegenerative diseases.
authors.affiliation: Department of Neurological Sciences, Federico II University, 80131 Naples, Italy. colao@unima.it
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Pellecchia
authors.forename: Rosario
authors.initials: R
authors.lastname: Pivonello
authors.forename: Elena
authors.initials: E
authors.lastname: Salvatore
authors.forename: Antongiulio
authors.initials: A
authors.lastname: Faggiano
authors.forename: Paolo
authors.initials: P
authors.lastname: Barone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Michele
authors.forename: Gaetano
authors.initials: G
authors.lastname: Lombardi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Colao
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filla
mesh_terms: D001120:Arginine; D016022:Case-Control Studies; D003000:Clonidine; D003937:Diagnosis, Differential; D005260:Female; D013006:Growth Hormone / Q000097:blood*; D013007:Growth Hormone-Releasing Hormone; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000097:blood / Q000175:diagnosis*; D010300:Parkinson Disease / Q000097:blood / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D013132:Spinocerebellar Degenerations / Q000097:blood / Q000175:diagnosis*; D013268:Stimulation, Chemical; D013565:Sympatholytics
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D013565:Sympatholytics; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D001120:Arginine; D003000:Clonidine