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The treadmill exhausting test is not suitable for screening of growth hormone deficiency!
J Donaubauer1, J Kratzsch, C Fritzsch
1Clinical Chemistry and Molecular Diagnostics, Children's Hospital, University of Leipzig, Oststrasse 21-25, D-04317 Leipzig, Germany. juliandonaubauer@web.de
Insights
The treadmill exhausting test is not recommended for diagnosing growth hormone deficiency in children. Pharmacological tests are more reliable for assessing growth hormone (GH) response in pediatric endocrinology.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Diagnostic Testing
Background:
- Short stature in children necessitates accurate diagnosis of growth hormone (GH) deficiency.
- Pharmacological stimulation tests are the current standard for assessing GH release.
Purpose of the Study:
- To evaluate the efficacy of a modified treadmill exhausting test as a diagnostic tool for GH deficiency in children.
- To compare the GH response during a maximal exercise test with standard pharmacological stimulation tests.
Main Methods:
- Seventy-seven children with short stature underwent a treadmill exhausting test to individual exhaustion.
- Each child also completed at least one pharmacological GH stimulation test.
- Heart rate, workload, and oxygen consumption were monitored to determine individual exhaustion.
Main Results:
- Pharmacological tests yielded significantly higher mean peak GH concentrations (16.1 ng/ml) compared to the treadmill test (5.0 ng/ml) in normally growing children.
- In children with GH deficiency, pharmacological tests showed a mean peak GH of 5.5 ng/ml versus 4.1 ng/ml for the treadmill test.
- The treadmill test demonstrated 90% sensitivity but only 11% specificity for diagnosing GH deficiency compared to pharmacological methods.
Conclusions:
- The treadmill exhausting test is not a reliable method for diagnosing growth hormone deficiency in pediatric patients.
- Pharmacological stimulation tests remain the preferred method for GH assessment in clinical pediatric endocrinology practice.
Background/Method:
We compared the growth hormone response to a modified exercise test--the treadmill exhausting test--to pharmacological stimulation tests in 77 children with short stature. Each child underwent the treadmill test to individual exhaustion and at least one pharmacological test for GH stimulation. To determine the point of individual exhaustion, the heart rate, workload and oxygen consumption were measured.
Results:
The mean +/- SEM peak GH concentration (ng/ml) in 47 small, normally growing children (group 1) was 16.1 +/- 1.3 in the pharmacological tests vs. 5.0 +/- 0.6 after a treadmill exhausting test. Thirty children with GH deficiency (group 2) had mean +/- SEM peak GH concentrations (ng/ml) of 5.5 +/- 0.5 in the pharmacological tests and 4.1 +/- 0.7 after physical exercise. The groups differed significantly in the pharmacological tests (p < 0.001) but not in the exhausting test. We found a 90% sensitivity but only a 11% specificity for the treadmill exhausting test compared to the diagnosis obtained by pharmacological testing.
Conclusion:
We do not recommend the treadmill exhausting test in clinical practice of pediatric endocrinology at all.