Confirmation of severe GH deficiency after final height in patients diagnosed as GH deficient during childhood

• Published in: Clinical endocrinology (Oxford) 2002-04, Vol.56 (4), p.503-507
• Main Authors: Attanasio, Andrea F., Howell, Simon, Bates, Peter C., Blum, Werner F., Frewer, Paul, Quigley, Charmian, Shalet, Stephen M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Biological and medical sciences; Body Height; Body Mass Index; Child; Endocrinopathies; Female; Functional investigation of endocrine glands and genital system; Human Growth Hormone - blood; Human Growth Hormone - deficiency; Human Growth Hormone - therapeutic use; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Insulin-Like Growth Factor Binding Protein 3 - blood; Insulin-Like Growth Factor I - metabolism; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1046/j.1365-2265.2002.01515.x

Summary objective Human GH treatment of patients with childhood‐onset (CO) growth hormone deficiency (GHD) ceases when they reach final height; this provides an opportunity to retest GH status in all patients before determining whether GH therapy will be required in adult life. At present, the diagnostic approach to these patients is not fully standardized. This study aimed to characterize a large group of previously GH‐treated CO GHD patients and establish their GH status. patients and methods The multinational study included 167 patients diagnosed as GH deficient and treated with hGH to final height during childhood. Mean age was 19·2 years and mean height standard deviation score (SDS) was –1·08. Peak serum GH concentrations were determined in standard GH stimulation tests. IGF‐I and IGFBP‐3 concentrations were determined at a central laboratory and converted to SDS values by reference to a normal population. results Using only a peak GH value of less than 3 µg/l (1 mg = 3 U) in stimulation tests as the cut‐off, 133 (79·6%) patients would be classed as GH deficient. Using only an IGF‐I value less than –2 SDS as the cut‐off, 134 (80·2%) patients would be classed as GH deficient. However, by using both criteria there were 120 (71·9%) patients who were definitely severely GH deficient (group 1) and 20 (12·0%) who were not GH deficient (group 2), leaving 14 (8·4%) classed as GH deficient from IGF‐I SDS only (group 3) and 13 (7·8%) classed as GH deficient from stimulation test only (group 4). There was no difference between the groups in height SDS or body mass index (BMI), but the GH‐deficient patients tended to have been diagnosed at a younger age (group 1, 8·2 ± 3·9; group 2, 10·0 ± 4·0; P = 0·052). For patients classed as GH deficient compared with those not GH deficient, the percentage of males was lower (group 1, 64·2%; group 2, 90·0%; P = 0·022) and the percentage with multiple pituitary hormone deficiencies was higher (group 1, 81·7%; group 2, 20·0%; P