Title:“Non-Classical” Indication for Provocative Testing of Growth Hormone: A Retrospective Cohort Study in Adult Patients Under Replacement Therapy
Volume: 21
Issue: 8
Author(s): Antonio Mancini*, Carmine Bruno, Edoardo Vergani, Alessandro Brunetti, Gerardo Palmisano and Alfredo Pontecorvi
Affiliation:
- Operative Unit of Endocrinology, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome,Italy
Keywords:
Pituitary, growth hormone, hypopituitarism, personalized medicine, metabolic syndrome, infertility.
Abstract:
Background: Adult growth hormone deficiency (GHD) is considered a rare condition.
Current guidelines state that GH provocative test is indicated in patients affected by organic hypothalamic/
pituitary disease or with a history of head injury, irradiation, hemorrhage or hypothalamic
disease with multiple pituitary deficiencies. Nevertheless, the clinical picture related to GHD
may be subtle.
Objective: We have retrospectively evaluated the indication to GHRH+arginine test in our monocentric
cohort of patients treated with hrGH in order to assess whether other conditions had been
considered as a rationale for provocative testing.
Methods: Ninety-six patients (51 females and 45 males), aged 19-67 years were included. The
GHRH+arginine test had been performed in 29 patients with organic hypothalamic/pituitary disease
and in 4 patients for Childhood onset-GHD (CoGHD). In other patients, the diagnosis was suspected
for “non classical” reasons in the clinical picture suspected for GHD.
Results: Classical indications included previously known primary empty sella (n=15), pituitary
surgery (n=14), pituitary cyst (n=1), non-secreting pituitary tumors (n=3) but more than half of the
patients (57.3%) had been studied for “non classical” indications: metabolic syndrome (n=25), asthenia
(n=13), heart failure (n=4), osteoporosis (n=6), unexplained hypoglycaemia (n=1) and infertility
(n=6). The latter represented a significant percentage in the male subgroup under 45 ys.
IGF-1 levels were lower than 50th percentile in 63% of patients. Finally, among non-classical reasons,
organic pituitary disease was discovered in 22 patients.
Conclusion: Idiopathic GHD may be unrecognized due to its subtle manifestations and that an extended
use of dynamic GH tests may reveal such conditions. A potential field of investigation
could be to identify subsets of patients with clinical conditions caused or worsened by underlying
unrecognized GHD.
