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Premarin priming does not alter growth hormone release following exercise
Insights
Premarin priming does not improve growth hormone release in prepubertal children. Combining estrogen priming with exercise and glucose tests is not more effective than exercise screening alone for diagnosing growth hormone deficiency.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Diagnostic Screening
Background:
- Assessing growth hormone (GH) deficiency in children is crucial for timely intervention.
- Standard screening tests for GH deficiency include exercise and glucose tolerance tests.
- Estrogen priming (e.g., with Premarin) has been explored to enhance GH release during testing.
Purpose of the Study:
- To evaluate the efficacy of Premarin priming on exercise-induced growth hormone release in prepubertal children.
- To determine the value of combining multiple GH screening agents (estrogen, glucose, exercise) in a large pediatric cohort.
- To assess the impact of age on GH response to screening tests.
Main Methods:
- A study involving 205 short, healthy prepubertal children (below 5th percentile height).
- Group 1 (n=144): Exercise test following glucose ingestion.
- Group 2 (n=61): Estrogen (Premarin) priming before glucose and exercise testing.
Main Results:
- Premarin priming did not significantly increase the number of children responding to exercise or glucose challenges.
- Response rates (GH increase ≥ 8 ng/ml) were high and similar: 86% (non-primed) vs. 88.5% (primed).
- Younger age (≤ 5 years) correlated with lower post-exercise GH levels and higher test failure rates.
Conclusions:
- Premarin priming does not enhance the growth hormone releasing capacity of prepubertal children during exercise.
- Combined screening tests (exercise, glucose, estrogen) offer no advantage over exercise screening alone for GH deficiency diagnosis.
- Glucose loading alone is insufficient to rule out GH deficiency in most children evaluated.
Abstract:
We evaluated the usefulness of premarin priming on exercise induced growth hormone release and the value of combining several growth hormone screening agents in a large population of prepubertal children. Two hundred five short healthy prepubertal children growing below the 5th percentile in height were studied. One hundred forty-four were screened with exercise following glucose ingestion, while 61 were primed with estrogen prior to glucose and exercise testing. Premarin priming did not significantly increase the number of our patients who responded to exercise nor to glucose; 86% and 88.5% of non-primed and primed patients, respectively, responded with a growth hormone increase greater than or equal to 8 ng/ml following exercise and glucose. Glucose loading alone was not associated with a high enough growth hormone rise to rule out growth hormone deficiency in most of our children. Age (less than or equal to 5 yr) was associated with lower post-exercise growth hormone levels and a higher failure rate to testing in both primed and non primed children. Premarin priming does not seem to alter the growth hormone releasing capacity to exercise of prepubertal children. The combined use of exercise, glucose loading and premarin priming in a single screening test does not improve on the results obtained by growth hormone exercise screening alone.