Chonnam Med J.  2015 Apr;51(1):33-38. 10.4068/cmj.2015.51.1.33.

Growth Hormone Responses to Provocative Tests in Children with Short Stature

• Rhee N
• Oh KY
• Yang EM
• Kim CJ

• KMID: 2172145
• DOI: http://doi.org/10.4068/cmj.2015.51.1.33

Abstract

Growth hormone deficiency (GHD) is defined as a serum peak GH concentration <10 ng/mL with provocation as tested by a combination of at least two separate tests. The aim of this study was to compare two standard tests, insulin and levodopa (L-dopa), with a primary focus on specificity and accuracy. Clinical data were collected retrospectively from a review of 120 children who visited the pediatric endocrine clinic at Chonnam National University Hospital for the evaluation of short stature between January 2006 and April 2014. Subjects underwent GH provocation tests with insulin and L-dopa. Blood samples were obtained at 0, 15, 30, 45, 60, 90, and 120 min after administration, and GH levels were measured. In the insulin test, serial glucose levels were also checked, closely monitoring hypoglycemia. A total of 83 children (69.2%) were diagnosed with GHD and 37 children (30.8%) were diagnosed with idiopathic short stature (ISS). Peak GH levels were achieved an average of 45 min after the administration of insulin and L-dopa for both groups. The specificity and accuracy were 78.4% and 93.6% for the insulin test and 29.7% and 79.2% for L-dopa test, respectively. In the ISS group, the cumulative frequency of a GH cutoff value of >10 ng/mL at 120 min was 75.6% after insulin stimulation compared with 35.1% after L-dopa stimulation. Considering these results, we recommend performing the insulin test first to exclude ISS and then the L-dopa test for the diagnosis of GHD. This way, ISS patients are diagnosed after a single test, thus reducing hospital days and the burden of undergoing two serial tests.

Keyword

Growth hormone; Dwarfism; Child

MeSH Terms

Child*
Diagnosis
Dwarfism
Glucose
Growth Hormone*
Humans
Hypoglycemia
Insulin
Jeollanam-do
Levodopa
Retrospective Studies
Sensitivity and Specificity
Glucose
Growth Hormone
Insulin
Levodopa

Figure

• 

  FIG. 1 Comparison of peak GH concentrations following L-dopa (A) and insulin (B) stimulation tests between the GHD patients (n=83) and the ISS patients (n=37). Box-plots show the median, interquartile range, outliers, and extreme cases. GH: growth hormone, GHD: growth hormone deficiency, ISS: idiopathic short stature.

• 

  FIG. 2 Comparison of GH concentrations at each time point after L-dopa (A) and insulin (B) stimulation tests between the GHD and ISS patients. Data are presented as median and 95% confidence interval (CI). GH: growth hormone, GHD: growth hormone deficiency, ISS: idiopathic short stature.

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