ESPE2021 ePoster Category 1 Growth Hormone and IGFs B (10 abstracts)
Diagnosing growth hormone deficiency - Can a combined arginine and clonidine stimulation test replace two separate tests?
Tal Oron 1,2 , Avihu Krieger 2 , Michal Yakobovich-Gavan 1,2 , Ariel Tenenbaum 1,2 , Rotem Diamant 1 , Moshe Phillip 1,2 & Liora Lazar 1,2
1Schneider Children’s Medical Center of Israel, Petach-Tikva, Israel; 2Tel Aviv University, Tel- Aviv, Israel
Objective: Given a large number of false-positive growth hormone deficiency (GHD) diagnoses from a single GH stimulation test in normal children, two different pharmacological tests, performed on separate days or sequentially, are required. This study aims to assess the reliability and safety of a combined clonidine-arginine stimulation test (CACST).
Design: Retrospective, single-center, observational study.
Methods: During 2017-2019, 515 children aged > 8 years underwent GH stimulation tests [CACST-362 or clonidine-first stimulation test (CST)-153]. The main outcome measures used to compare the tests were GH response (sufficiency/deficiency) and amplitude and timing of peak GH and safety parameters.
Results: Population characteristics: median age-12.2 years (IQR 10.7, 13.4), boys -331 (64%), prepubertal-282 (54.8%). GHD rate was comparable with 12.7% for CACST and 14.4% for CST followed by confirmatory test (glucagon/arginine), P = 0.609. Peak GH was higher and occurred later in response to CACST compared to CST [14.6 ng/ml (IQR 10.6, 19.4) vs. 11.4 ng/ml (IQR 7.0, 15.8), P < 0.001; 90 min (IQR 60, 90) vs. 60 min (IQR 60,90), P < 0.001, respectively]. Peak GH in response to CACST was not modified by pubertal stage. No serious adverse events occurred following CACST.
Conclusion: Our findings demonstrate the reliability and safety of CACST in detecting GHD in late childhood and adolescence, suggesting that it may replace separate or sequential GHSTs. By diminishing the need for a second GHST, CACST saves time, is more cost-effective, and reduces discomfort for children, their caregivers, and medical staff.
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