ESPE2021 ePoster Category 2 Growth and syndromes (to include Turner syndrome) (56 abstracts)
An Italian survey on GH stimulation tests and their adverse side effects.
Alessandro Salvatoni 1 , Massimo Agosti 1 , Tommaso Aversa 2 , Sara Azzolini 3 , Mauro Bozzola 4 , Valeria Calcaterra 4 , Giuliana Marcella Cardinale 5 , Manuela Caruso 6 , Paolo Cavarzere 7 , Valentino Cherubini 8 , Sara Ciccone 9 , Laura Dipasquale 10 , Daniela Driul 11 , Maria Felicia Faienza 12 , Concetta FORINO 13 , Anna Grandone 14 , Chiara Guzzetti 15 , Maria Laura Iezzi 16 , Lorenzo Iughetti 17 , Sandro Loche 15 , Mohamad Maghnie 18 , Chiara Mameli 19 , Valentina Mancioppi 20 , Patrizia Matarazzo 21 , Beatrice Messini 22 , Maria Parpagnoli 23 , Maria Carolina Salerno 24 , Gianluca Tornese 25 , Adolfo Andrea Trettene 26 , Silvia Vannelli 27 , Stefano Zucchini 28 & Maurizio Delvecchio 29
1Università degli Studi dell’Insubria, VARESE, Italy; 2Università degli Studi di Messina, MESSINA, Italy; 3Università degli Studi di Padova, PADOVA, Italy; 4Università degli Studi di Pavia, PAVIA, Italy; 5Divisione di Pediatria, Ospedale "F.Ferrari", Casarano, CASARANO (LE), Italy; 6Università degli Studi di Catania, CATANIA, Italy; 7Clinica Pediatrica, Az.Osp. Univ. Integrata, VERONA, Italy; 8Divisione di Diabetologia Pediatrica, Ospedale "Salesi", ANCONA, Italy; 9Ospedale Buffalini, CESENA, Italy; 10Az.Osp.San Camillo-Fornanini, ROMA, Italy; 11Clinica Pediatrica Az. Osp. Univ., UDINE, Italy; 12Università degli Studi, BARI, Italy; 13Fondazione Poliambulanza Istituto Ospedaliero, BRESCIA, Italy; 14Università della Campania "Luigi Vanvitelli", NAPOLI, Italy; 15SSD Endocrinologia Pediatrica, Ospedale Pediatrico Microcitemico, CAGLIARI, Italy; 16Dipartimento di pediatria Università, L’AQUILA, Italy; 17Università di Modena e Reggio, MODENA, Italy; 18IRCCS Ospedale Gaslini, GENOVA, Italy; 19Ospedale Sacco, Università degli Studi di Milano, MILANO, Italy; 20SCDU di Pediatria, Università del Piemonte Orientale, NOVARA, Italy; 21Dipartimento di Endocrinologia Pediatrica, Ospedale Pediatrico Regina Margherita, TORINO, Italy; 22U.O. Pediatria, FOLIGNO (PG), Italy; 23Ospedale Pediatrico Meyer, FIRENZA, Italy; 24Università "Federico II", Napoli, Italy; 25Ospedale Pediatrico Burlo Garofolo, TRIESTE, Italy; 26UO Pediatria, ASST dei sette laghi, VARESE, Italy; 27Unità di Auxologia, Università di Torino, TORINO, Italy; 28Az.Osp.Univ. "S.Orsola-Malpighi", BOLOGNA, Italy; 29Ospedale Pediatrico Giovanni XXIII, BARI, Italy
Introduction: The diagnosis of GHD requires the coexistence of anamnestic, auxological and laboratory data. The latter are burdened by the poor accuracy and adverse effects of the stimulation tests. A recent european audit (Horm Res Paediatr 2019;92(3): 150-156) on GH diagnostic reported as preferred tests in Italy Insulin tolerance test (ITT), glucagon, clonidine, arginine and Arg-GHRH. We conducted a survey to explore which of them are most used in Italy and which are the most frequent adverse events. Materials and methods: We have proposed an on-line 14 multiple choice questionnaire to 46 pediatric centers of 38 Italian towns to detect the stimuli used for the diagnosis of GHD and the adverse effects observed. Results: 29/46 centers answered the questionnaire. 40% of the centers performed more than 100 tests/year and the remaining between 20 and 100 tests/year. The most commonly stimuli used as primary screening were arginine (70% for all ages), glucagon (10% <3-year-old) and clonidine (23% ≥3-year-old). The most commonly stimuli used to confirm GH deficiency were glucagon (40%), arginine (23%) and Arg-GHRH (13%) in <3-year-old children, and ITT (20%), Glucagon (20%), Clonidine (20%) and Arginine (17%) in older children. The most commonly used stimulus for retesting was Arg-GHRH (88%). The choice of the types of stimulus to be used was independent of the number of tests carried out per year in each center. 18 centers (60%) reported side effects. The most frequent side effects referred to ITT [prolonged hypoglycemia (6) with (3) or without loss of consciousness (3) or seizures (1) reported by 6 centers], arginine [hematuria (3) or extravasation necrosis (2) with keloid outcome (1); reported by 6 centers], clonidine [prolonged hypotension (12); or prolonged sleepiness (1) reported from 13 centers] and glucagon [prolonged hypoglycemia; reported from 6 centers]. Conclusions: On the basis of the present survey, the most frequently used stimuli for the diagnosis of GHD were arginine, as first test, glucagon as confirming test in < 3 year old children, ITT, Glucagone and Clonidine, with equal frequency, as confirming test in older children and Arg-GHRH as retesting at the end of the therapy. Although all tests for GH secretion assessment have adverse side effects, most centers prefer to avoid ITT due to the hypothetical risk of severe hypoglycemia with loss of consciousness or seizures. Unfortunately there are no reliable data on the real frequency of such adverse events during ITT.
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