Diagnosis of growth hormone (GH) deficiency: comparison of pituitary stalk interruption syndrome and transient GH deficiency.
BACKGROUND
Most patients with childhood non-organic growth hormone (GH) deficiency (GHD) produce a normal GH peak as young adults. Our objectives were to better define this transient GHD and evaluate the factors influencing the growth response of patients with pituitary stalk interruption syndrome (PSIS).


METHODS
We studied 72 prepubertal patients with a GH peak < 6.7 ng/ml after 2 stimulation tests, treated with 0.2 mg GH/kg/w for at least 3 years. Group 1 (n = 53, 4.7 +/- 4.0 years) had PSIS and Group 2 (n = 19, 9.2 +/- 3.0 years) had transient GHD and normal pituitary.


RESULTS
At diagnosis, 64% of Group 1 and one Group 2 were < 5 years old. The growth rate of 59% Group 1 and two Group 2 patients was < or = -2 SDS. The GH peak of 64% Group 1 patients and no Group 2 patients was < 3 ng/ml. The plasma insulin-like growth factor-1 of all Group 1 and all but one Group 2 patients was < or = -2 z scores.During the first year of GH treatment, the growth rate was > or = 2 SDS in 81% Group 1 and 37% Group 2 patients. In Group 1, it was negatively correlated with the GH peak before treatment (P < 0.03), and with the difference between the target and adult heights (P < 0.01).The height gain SDSs between diagnosis and adult height were 1.7 +/- 1.2 in Group 1 (n = 30) and 1.08 +/- 0.8 in Group 2 (n = 12, P = 0.05).


CONCLUSIONS
The factors of the growth response to GH treatment should be analysed separately for each population: with and without PSIS or other markers.
Université Paris Descartes and AP-HP, Hôpital Bicêtre, Unité d'Endocrinologie Pédiatrique, Le Kremlin Bicêtre 94275, France. louvelmurielle@msn.com
Murielle
M
Louvel
Mariana
M
Marcu
Christine
C
Trivin
Jean-Claude
JC
Souberbielle
Raja
R
Brauner
D000293:Adolescent; D001827:Body Height / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004393:Dwarfism, Pituitary / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency* / Q000378:metabolism / Q000627:therapeutic use; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008297:Male; D010903:Pituitary Gland, Anterior / Q000378:metabolism / Q000473:pathology; D012189:Retrospective Studies; D013577:Syndrome; D013972:Thyrotropin / Q000172:deficiency; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome
D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone