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Sex hormone priming prior to the combined hypoglycaemia test

W Hamilton, M M Khattab

    Acta Endocrinologica. Supplementum
    |January 1, 1986
    PubMed

    Insights

    Priming short stature children with sex hormones does not improve growth hormone (GH) response during insulin hypoglycemia testing (IHT). This suggests a lack of partial GH deficiency diagnosis and highlights the importance of pituitary response to releasing hormones for effective treatment.

    Area of Science:

    • Pediatric Endocrinology
    • Growth Hormone Physiology
    • Hormone Replacement Therapy

    Background:

    • Short stature in children is a common clinical concern.
    • The insulin hypoglycemia test (IHT) is used to assess growth hormone (GH) secretion.
    • The role of sex steroid priming in GH response during IHT requires further elucidation.

    Purpose of the Study:

    • To investigate the effect of sex steroid priming (17 beta-oestradiol and testosterone) on GH response in short stature children undergoing IHT.
    • To evaluate the diagnostic utility of IHT in identifying partial GH deficiency states.
    • To explore the implications of combining IHT with gonadotropin-releasing hormone (Gn-RH) and thyrotropin-releasing hormone (TRH) infusions for diagnosing hypothalamic-pituitary axis dysfunction.

    Main Methods:

    • Three groups of short stature children were studied: unprimed, 17 beta-oestradiol primed, and testosterone primed.
    • Insulin hypoglycemia test (IHT) was performed, with insulin dosage adjusted to achieve a blood glucose nadir of 1 mmol/L.
    • Plasma GH levels were measured, and IHT was combined with Gn-RH and TRH infusion in some cases.

    Main Results:

    • Sex steroid priming with either 17 beta-oestradiol or testosterone did not improve plasma GH responses when the blood glucose nadir was below 10 mU/L.
    • The data do not support the diagnosis of a partial GH deficiency state based on these findings.
    • Combined IHT with Gn-RH and TRH infusion may help differentiate GH-releasing hormone (GH-RH) deficiency, corticotropin-releasing factor (CRF) deficiency, pituitary insensitivity, or generalized pituitary synthetic failure.

    Conclusions:

    • Sex steroid priming does not enhance GH secretion during IHT in short stature children.
    • The concept of a partial GH deficiency state is questioned based on the lack of response to priming.
    • Effective treatment with analogue therapies for GH deficiency is contingent upon demonstrating pituitary responsiveness to releasing hormones; otherwise, treatment failure is likely.

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