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Effects of estrogen on growth hormone following clonidine stimulation
D M Wilson1, R J Dotson, E K Neely
1Department of Pediatrics, Stanford University, Calif.
Insights
Estrogen priming does not improve the diagnostic accuracy of clonidine stimulation tests for growth hormone (GH) deficiency in short children. This study found no significant difference in GH response with or without estrogen pretreatment.
Area of Science:
- Pediatric Endocrinology
- Growth Hormone Physiology
- Diagnostic Test Evaluation
Background:
- Short stature in children often necessitates growth hormone (GH) assessment.
- Clonidine hydrochloride stimulation tests are used to evaluate GH secretion.
- Estrogen priming is sometimes employed to potentially enhance GH release during stimulation tests.
Purpose of the Study:
- To evaluate the efficacy of estrogen priming in augmenting the growth hormone response to clonidine hydrochloride stimulation.
- To determine if estrogen pretreatment improves the diagnostic yield of clonidine GH stimulation tests in short children.
Main Methods:
- A randomized controlled trial involving short children undergoing clonidine GH stimulation tests.
- Subjects were assigned to receive either estrogen pretreatment or no pretreatment.
- Growth hormone levels were measured before and at timed intervals after clonidine administration.
Main Results:
- No statistically significant differences in mean growth hormone concentrations were observed between the estrogen-primed and non-primed groups.
- The diagnostic performance of the clonidine GH stimulation test was not enhanced by estrogen pretreatment.
Conclusions:
- Estrogen priming does not appear to be beneficial for improving the diagnostic accuracy of clonidine GH stimulation tests.
- The study suggests that estrogen pretreatment does not increase the diagnostic yield of this specific GH assessment.
Objective:
To test the usefulness of estrogen priming to enhance the growth hormone (GH) response following stimulation with clonidine hydrochloride in short children.
Design:
Randomized and patient series.
Setting:
Pediatric endocrine clinic in a referral center.
Subjects:
Seventy-three children (63% male) between 1.8 and 15.4 years of age (mean age, 8.8 years) with growth problems who underwent clonidine GH stimulation tests were randomly assigned to receive either estrogen pretreatment or no pretreatment. An additional 49 subjects, seen before or after the randomized study and who did not receive conjugated estrogen, are also described.
Selection Procedure:
Consecutive sample.
Intervention:
Estrogen pretreatment consisted of 2.5 mg of conjugated estrogen (Premarin) to be taken the evening before and the morning of the clonidine GH stimulation test. Growth hormone concentrations were determined before and 60 and 90 minutes after the subjects received oral clonidine hydrochloride (5 micrograms/kg) by a laboratory blinded to the subject's estrogen status. Growth hormone concentrations greater than 10 micrograms/L were considered normal.
Results:
Eight of the 73 subjects failed both clonidine and arginine-insulin GH stimulation tests. We analyzed the GH data from the 65 GH-sufficient subjects to determine the effect of estrogen pretreatment on the specificity of the clonidine GH stimulation test. There were no statistically significant differences in the mean GH concentrations between the two groups at any time point during the test.
Conclusions:
Our data demonstrate that estrogen priming does not improve the diagnostic yield of clonidine GH stimulation tests.