Growth hormone provocation tests and their prediction in the growth of children treated for acute lymphoblastic leukemia.
OBJECTIVE
The aim of this study was to evaluate the positive predictive value of two growth hormone stimulation tests (insulin-induced hypoglycemia and clonidine) for stature below percentile 10 in patients treated for acute lymphoblastic leukemia in childhood.


METHODS
The study population was a cohort of 30 patients (aged 14.1+/-2.9 years; 20 male) treated for acute lymphoblastic leukemia during childhood and then examined after insulin-induced hypoglycemia (30 patients) and clonidine (16 patients) tests. The follow-up time was 7.7+/-2.8 years since treatment and 2.3+/-1.3 years after administration of the tests.


RESULTS
In the last evaluation, 12 patients (40%) were below and 18 (60%) were above percentile 10. The insulin-induced hypoglycemia test response was: 9 patients (30%) had growth hormone peak <5 ng/mL and 19 (63.3%) <7 ng/mL. The clonidine test response was: 7 patients had growth hormone peak <5 ng/mL and 8 (50%) <7 ng/mL. For stature below of the percentile 10, the positive predictive values of insulin-induced hypoglycemia test (33%) and clonidine (28%) were low when growth hormone peak <5 ng/mL was considered; however, when growth hormone peak <7 ng/mL was considered, the positive predictive values were 83% and 50% for the insulin-induced hypoglycemia and clonidine tests, respectively.


CONCLUSIONS
In patients treated for acute lymphoblastic leukemia in childhood, the positive predictive values for statural deficit of both tests were low, except for the insulin-induced hypoglycemia test when a growth hormone peak <7 ng/mL was considered.
Papadia
C
C
Department of Neurosurgery, Hospital de Base do Distrito Federal, Brasília, Brazil.
Naves
L A
LA
Motta
L D C
LD
Barboza Filho
R F
RF
Suzuki
M T M
MT
Casulari
L A
LA
D000293:Adolescent; D000316:Adrenergic alpha-Agonists; D001827:Body Height / Q000187:drug effects* / Q000528:radiation effects*; D002648:Child; D002675:Child, Preschool; D003000:Clonidine; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency*; D006801:Humans; D007004:Hypoglycemic Agents; D007328:Insulin; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011237:Predictive Value of Tests
D000316:Adrenergic alpha-Agonists; D007004:Hypoglycemic Agents; D007328:Insulin; D019382:Human Growth Hormone; D003000:Clonidine