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Growth hormone provocation tests and their prediction in the growth of children treated for acute lymphoblastic
C Papadia1, L A Naves, L D C Motta
1Department of Neurosurgery, Hospital de Base do Distrito Federal, Brasília, Brazil.
Insights
The insulin-induced hypoglycemia test is more reliable for predicting growth deficits in childhood leukemia survivors, especially when growth hormone peaks are below 7 ng/mL. Clonidine test results were less predictive for identifying short stature in these patients.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Growth Hormone Disorders
Background:
- Childhood acute lymphoblastic leukemia (ALL) survivors are at risk for growth deficits.
- Growth hormone (GH) deficiency is a potential complication following ALL treatment.
- Accurate assessment of GH status is crucial for timely intervention.
Purpose of the Study:
- To evaluate the positive predictive value (PPV) of two GH stimulation tests: insulin-induced hypoglycemia (IIT) and clonidine (CT).
- To determine the effectiveness of these tests in identifying short stature (stature below the 10th percentile) in pediatric ALL survivors.
Main Methods:
- A cohort of 30 pediatric ALL survivors (mean age 14.1 years) underwent IIT and CT.
- GH levels were measured post-stimulation, with peaks recorded.
- PPV was calculated for GH peaks <5 ng/mL and <7 ng/mL for both tests in relation to stature below the 10th percentile.
Main Results:
- 40% of patients were below the 10th percentile for stature.
- When considering GH peak <7 ng/mL, the PPV for short stature was 83% for IIT and 50% for CT.
- Lower GH peaks (<5 ng/mL) yielded low PPVs for both tests (33% for IIT, 28% for CT).
Conclusions:
- The IIT demonstrated a higher PPV for identifying statural deficit in pediatric ALL survivors compared to CT, particularly when a GH peak <7 ng/mL was used as the threshold.
- Both GH stimulation tests showed limited predictive value for short stature when lower GH peaks (<5 ng/mL) were considered.
- The findings suggest that IIT may be a more reliable tool for assessing GH status in this specific patient population.
Aim:
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.
