Assessing short-statured children for growth hormone deficiency
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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
W Chemaitilly1, C Trivin, J-C Souberbielle
1Université René-Descartes and Pediatric Endocrinology Unit, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, France.
Insights
Measuring growth hormone (GH) during sleep and priming boys with testosterone can help diagnose GH deficiency in short children. Further imaging is needed for suspected anatomical issues.
Area of Science:
- Pediatric Endocrinology
- Growth Disorders
Background:
- Short stature in children often necessitates evaluation for growth hormone (GH) deficiency.
- Accurate diagnosis is crucial for timely intervention and optimal growth outcomes.
Purpose of the Study:
- To identify the most effective diagnostic tools for growth hormone (GH) deficiency in short-statured children.
- To optimize the diagnostic workup for pediatric GH deficiency.
Main Methods:
- Patients were categorized into prepubertal (n=113) and pubertal (n=112) groups.
- Measurements included mean plasma GH during sleep, peak GH after provocative testing, and insulin-like growth factor I (IGF-I).
- Pubertal boys received testosterone priming (n=25).
Main Results:
- Mean GH during sleep was more frequently normal than peak GH or IGF-I.
- In prepubertal children, mean sleep GH correlated positively with height, growth rate, peak GH, and IGF-I.
- In pubertal children, mean sleep GH correlated positively with peak GH and IGF-I.
- Testosterone priming improved the normality rate of GH and IGF-I measurements.
- Patients with pituitary stalk interruption consistently showed low IGF-I.
Conclusions:
- Mean GH concentration during sleep and testosterone priming in boys can aid in excluding idiopathic GH deficiency.
- Magnetic resonance imaging is essential for identifying anatomical abnormalities when GH and/or IGF-I levels are low.
Aim:
To optimize the workup of short-statured children by defining the most appropriate tools for diagnosing growth hormone (GH) deficiency.
Methods:
Patients were assigned to prepubertal (n = 113) or pubertal (n = 112, including 25 boys primed with testosterone) age groups. Mean plasma GH concentration during sleep, GH peak after provocative test, and insulin-like growth factor I (IGF-I) were measured in a single evaluation.
Results:
The mean GH concentration during sleep was more often normal (n = 155) than the GH peak after provocative tests (n = 105) or the IGF-I concentration (n = 88). Prepubertal patients with a normal body mass index (BMI) had mean GH concentrations during sleep that correlated positively with height, growth rate, GH peak after provocative tests, and IGF-I (p < 0.0005 for all) and negatively with the difference between target and patient heights (p = 0.01) and BMI (p < 0.05). Pubertal patients with a normal BMI had a mean GH concentration during sleep that correlated positively with GH after provocative tests (p < 0.0001) and IGF-I (p < 0.005). Mean GH concentration during sleep and IGF-I concentration for boys primed with testosterone were more often normal (n = 23) than the GH peak after provocative tests (n = 14). All 9 patients with pituitary stalk interruption had low IGF-I concentrations; 1 patient had a normal GH peak after provocative test, and 2 patients had normal mean GH concentrations during sleep.
Conclusions:
Measuring the GH concentration during sleep and priming boys with pubertal delay can help to exclude idiopathic GH deficiency. Magnetic resonance imaging is needed to exclude anatomic abnormalities when GH and/or IGF-I concentrations are low.
