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Twelve-hour spontaneous nocturnal growth hormone secretion in growth retarded patients
G L Spadoni1, S Cianfarani, S Bernardini
1Department of Pediatrics, 2nd University of Rome, Italy.
Insights
Nocturnal growth hormone (GH) secretion measurement effectively diagnoses GH deficiency in children. Lower GH levels in patients with total GH deficiency (TGHD), partial GH deficiency (PGHD), and idiopathic short stature (ISS) distinguish them from familial short stature (FSS) and constitutional growth delay (CGD).
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Diagnostic Medicine
Background:
- Short stature in children can stem from various conditions, including familial short stature (FSS), constitutional growth delay (CGD), growth hormone deficiency (GHD), and idiopathic short stature (ISS).
- Accurate diagnosis is crucial for appropriate management and treatment.
- Assessing spontaneous growth hormone (GH) secretion is a key component in diagnosing GHD.
Purpose of the Study:
- To evaluate the utility of 12-hour nocturnal GH secretion measurement in differentiating various causes of short stature in children.
- To determine if spontaneous nocturnal GH secretion patterns can distinguish between GHD and non-GHD short stature conditions.
Main Methods:
- Nocturnal GH secretion was measured over 12 hours in 30 children with diagnosed short stature conditions (FSS, CGD, TGHD, PGHD, ISS).
- Serum GH concentrations were sampled every 30 minutes.
- Growth velocity, expressed as SD from the mean for bone age, was correlated with GH secretion levels.
Main Results:
- Mean 12-hour nocturnal GH concentrations were significantly lower in children with total GH deficiency (TGHD), partial GH deficiency (PGHD), and idiopathic short stature (ISS) compared to those with familial short stature (FSS) and constitutional growth delay (CGD).
- No overlap in mean GH concentration values was observed between TGHD and FSS groups.
- A significant correlation (p < 0.001) was found between growth velocity SD and GH concentration.
- Children with growth velocity below the 3rd percentile for bone age consistently showed mean nocturnal GH concentrations below 4 ng/ml.
Conclusions:
- 12-hour spontaneous nocturnal GH secretion assessment, with sampling every 30 minutes, is a valuable tool for diagnosing GH deficiency in children.
- This method can effectively differentiate GH deficiency from other causes of short stature like FSS and CGD.
- Nocturnal GH secretion patterns provide clinically relevant information for pediatric growth disorders.
Abstract:
Twelve-hour nocturnal GH secretion was studied in 30 children with familial short stature (FSS), constitutional growth delay (CGD), total growth hormone deficiency (TGHD), partial growth hormone deficiency (PGHD), or idiopathic short stature (ISS). No difference was observed between subjects with FSS and children with CGD. The mean 12-hour serum GH concentration was significantly lower in patients with TGHD (p less than 0.001), children with PGHD (p less than 0.01), and subjects with ISS (p less than 0.01) than in subjects with FSS and CGD. No overlap was observed between the range of mean concentration values of children with TGHD and that of subjects with FSS. A significant correlation was found between growth velocity expressed as SD from the mean for bone age and GH concentration (p less than 0.001). All patients with a growth velocity less than 3rd percentile for bone age showed a mean nocturnal concentration less than 4 ng/ml. These data suggest that evaluation of 12-hour spontaneous nocturnal GH secretion with GH sampling every 30 minutes can be usefully employed in the diagnosis of GH deficiency.