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Growth hormone (GH) provocation tests and the response to GH treatment in GH deficiency
T J Cole1, P C Hindmarsh, D B Dunger
1Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London, UK. tim.cole@ich.ucl.ac.uk
Insights
The growth hormone (GH) provocation test is a valuable predictor of growth response in children with GH deficiency (GHD) during the first year of treatment. A year of GH therapy is recommended for borderline test results.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Therapy
- Clinical Diagnostics
Background:
- Growth hormone deficiency (GHD) affects childhood growth.
- Predicting growth response to GH treatment is crucial for optimizing therapy.
- The utility of GH provocation tests in predicting treatment outcomes requires further clarification.
Purpose of the Study:
- To identify factors influencing growth response to GH treatment in children with GHD.
- Specifically, to evaluate the predictive value of the GH provocation test result.
Main Methods:
- Analysis of 337 prepubertal GHD patients (<10 years) from the UK Pharmacia KIGS database.
- Patients had GH response to provocation test <20 mU/l.
- Outcome measured as annual change in height standard deviation score (SDS) over two years.
Main Results:
- Height increased by 0.74 SDS in year 1 and 0.37 SDS in year 2.
- GH provocation test result was the strongest predictor of first-year growth response.
- Lower GH provocation test results predicted significantly greater height increments in the first year.
Conclusions:
- The GH provocation test is a valuable predictor of first-year growth response in children with GHD.
- A trial of GH treatment for one year is recommended for patients with marginal provocation test results.
- Further assessment of standardized provocation test protocols is warranted.
Objective:
To identify factors, particularly the growth hormone (GH) provocation test result, affecting growth response to GH treatment in children with GH deficiency (GHD).
Subjects:
A total of 337 prepubertal GHD patients aged <10 years from the UK Pharmacia KIGS database (GH response to provocation test <20 mU/l).
Outcome Measure:
Annual change in height standard deviation score (SDS) (revised UK reference) in the first and second years of treatment.
Results:
Height increased by 0.74 SDS units (SD 0.39) in the first year of treatment and 0.37 units (SD 0.27) in the second. Adjusting for age, height, weight, midparent height, and injection frequency, the strongest predictor of first year growth response was the GH provocation test result; halving the result predicted an extra height increment of 0.09 units (p<0.0001). It predicted the second year response less well (p<0.0002) and after adjusting for the first year response was not predictive at all.
Conclusions:
Among patients referred for possible GHD, the GH provocation test, though not a gold standard for diagnosis, is a valuable predictor of growth response in the first year of treatment. A year's treatment is recommended for cases with a marginal provocation test result, with the option to continue treatment if the response is adequate. The value of unified protocols for single or repeated provocation tests needs to be assessed.
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