Background: GH deficiency (GHD) is routinely diagnosed on the basis of decreased GH peak in two stimulating tests (GHST). In Poland, few years ago, an assessment of nocturnal GH secretion after falling asleep (noctGH) has been introduced as a screening test in diagnosing GHD.
Objective and hypotheses: The aim of the study was to assess GH therapy effectiveness in children with decreased GHST with respect to noctGH.
Method: Retrospective analysis comprised 150 children with GHST in standard tests with clonidine and with glucagon <10.0 ng/ml, including 116 patients with noct GH <10.0 ng/ml (GHD1 Group) and 34 patients with noctGH >10.0 ng/ml, recruited prior to the introduction of screening test (GHD2 Group). First-year response to treatment: height velocity (HV) increase and IGF1 SDS increase was assessed in all the patients, while final height (FH) was attained by 32 patients in GHD1 Group and 16 ones in GHD2.
Results: In GHD1 Group, GH peak in stimulating tests (GHST) was 6.9±2.3 ng/ml, height SDS before treatment (hSDS-0) was −2.95±0.85, in 1st year of treatment HV increased from 3.8±1.4 to 9.8±2.0 cm/year, IGF1 SDS increased from −1.92±1.11 to 0.44±0.87, FH SDS was −1.23±0.68. In GHD2 Group, GHST was 8.2±1.9 ng/ml, hSDS-0 was -2,84±0.62, HV increased from 3.6±1.2 to 10.1±2.2 cm/year, IGF1 SDS increased from −1.84±1.18 to 0.70±0.92, FH SDS was −1.34±0.64. The differences in age, GH dose, therapy duration and all the analysed indices of GH therapy effectiveness between the Groups were insignificant, despite normal noctGH and significantly higher GHST (P<0.001) in GHD2 Group.
Conclusion: Assessment of GH secretion after falling asleep should no longer be the screening procedure in diagnosing GHD in children with short stature. Normal result of this test is not the sufficient basis for disqualification children with decreased GH peak in stimulating tests from GH therapy.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology