Abstract
The reliability of provacative stimuli of GH secretion in the diagnosis of GH deficiency it is still unclear. Until now normative values of GH response to various stimuli are scanty. To address this point, in a very large population of children with normal and familial short stature (n=432; 282 M and 150 F; age 10.6 ± 0.7 yrs, pubertal stage I-III) having normal spontaneous GH secretion and IGF-I levels, we studied the GH response to: a) physical exercise (PE; n=23); b) insulin-induced by poglycemia (IH; n=44; 0.1 U/kg regular insulin iv at 0 min); e) L-DOPA (n=37; 125, 250 and 500 mg orally for body weight <15, between 15 and 30, and > 30 kg, respectively); f) glucagon (GLU; n =40; 1 mg im at 0 min); g) pyridostigmine (PD; n = 51; 60 mg orally at 0 min); h) GHRH (n = 94; 1 μg/kg iv a 0 min); i) PD + GHRH (n = 84; PD given 60 min before GHRH); i) ARG + GHRH (n = 69; GHRRH at 0 min and ARG from 0 to 30 min). The mean (± SEM) peaks and ranges of GH responses to various stimuli were: a): PE: 12.2±1.3 μg/L; 3-28.3; b) IH: 13.4±1.5 μg/L: 2.7-46.4; c) ARG: 16.7±1.3 μg/L; 4.3-48.4; d) CLON: 18.1±1.4 μg/L; 3.8-86; e) L-DOPA: 13.9±1.6 μg/L: 1.9-40: f) GLU: 16.6±1.8 μg/L: 1.9-49.5: g)PD: 13.6+1.0 μg/L; 2.5-35; h) GHRH: 33.4±2.6 μg/L; 2.8-102.7. i) PD + GHRH: 47.5±1.8 μg/L; 19.6-92; j) ARG + GHRH: 62.1±2.8 μg/L: 20.4-107.0. The lower limit at 97% of confidence interval for various stimuli was: a)PE: 3.0; b)IH: 4.0; c)ARG: 4.4; d)CLON: 4.7; e)L-DOPA: 2.4; f)GLU: 3.1; g) PD:3.1; h)GHRH: 6.2; i)PD + GHRH: 22; j)ARG + GHRH: 27.3. Thus, in conclusion, our data show that all conventional stimuli of GH secretion sucha as PE, IH, ARG, CLON, L-DOPA, GLU as well as PD alone and GHRH alone have very low limits of normal peak GH response. These limits are lower than those classically indicated as 7 or 10 μg/L. When combined with PD or ARG, GHRH becomes the most powerful single test to explore the integrity of somatotroph cells. The lower limit of normal peak GH response to testing with GHRH combined with PD or ARG is over 20 μg/L. The availability of tests having an elevated lower limit of normality allows to better differntiate between normal and impaired pituitary function, thought a normal GH response to these tests does not rule out the existence of a hyposecretory state due to hypothalamic dysfunction.
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Bellone, J., Valente, F., Aimaretti, G. et al. PEAK GH RESPONSE TO VARIOUS PROVOCATIVE STIMULI IN CHILDREN WITH NORMAL AND FAMILIAL SHORT STATURE. Pediatr Res 33 (Suppl 5), S25 (1993). https://doi.org/10.1203/00006450-199305001-00134
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DOI: https://doi.org/10.1203/00006450-199305001-00134
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