Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?
To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of c...
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| Veröffentlicht in: | International journal of environmental research and public health 2019-01, Vol.16 (3), p.307 |
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| creator | Penta, Laura Cofini, Marta Lucchetti, Laura Zenzeri, Letizia Leonardi, Alberto Lanciotti, Lucia Galeazzi, Daniela Verrotti, Alberto Esposito, Susanna |
| description | To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of |
| doi_str_mv | 10.3390/ijerph16030307 |
| format | Article |
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Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone⁻releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<-2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than -2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.</description><identifier>ISSN: 1660-4601</identifier><identifier>ISSN: 1661-7827</identifier><identifier>EISSN: 1660-4601</identifier><identifier>DOI: 10.3390/ijerph16030307</identifier><identifier>PMID: 30678118</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Adolescent ; Adults ; Age ; Arginine ; Arginine - administration & dosage ; Blood ; Blood glucose ; Blood levels ; Body composition ; Body fat ; Body height ; Bone mass ; Child ; Child, Preschool ; Cholesterol ; Clonidine ; Drug Monitoring - methods ; Drug Monitoring - standards ; Dwarfism, Pituitary - drug therapy ; Endocrinology ; Female ; Glucose ; Glucose metabolism ; Growth Hormone - therapeutic use ; Growth hormone-releasing hormone ; Growth Hormone-Releasing Hormone - administration & dosage ; Growth hormones ; High density lipoprotein ; Homeostasis ; Hormone Replacement Therapy - methods ; Human Growth Hormone - blood ; Human Growth Hormone - deficiency ; Humans ; Insulin ; Insulin resistance ; Insulin-Like Growth Factor I - metabolism ; Insulin-like growth factors ; Lipid metabolism ; Lipids ; Low density lipoprotein ; Male ; Males ; Medical Overuse - prevention & control ; Medicine ; Metabolism ; Muscle strength ; NMR ; Nuclear magnetic resonance ; Physiology ; Pituitary gland ; Triglycerides</subject><ispartof>International journal of environmental research and public health, 2019-01, Vol.16 (3), p.307</ispartof><rights>2019. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 by the authors. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c418t-8b0fd21ab4c67331e488fda1618d8499187478b60e9ae9ab13c103efe1c48c963</citedby><cites>FETCH-LOGICAL-c418t-8b0fd21ab4c67331e488fda1618d8499187478b60e9ae9ab13c103efe1c48c963</cites><orcidid>0000-0003-4103-2837</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388362/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388362/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30678118$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Penta, Laura</creatorcontrib><creatorcontrib>Cofini, Marta</creatorcontrib><creatorcontrib>Lucchetti, Laura</creatorcontrib><creatorcontrib>Zenzeri, Letizia</creatorcontrib><creatorcontrib>Leonardi, Alberto</creatorcontrib><creatorcontrib>Lanciotti, Lucia</creatorcontrib><creatorcontrib>Galeazzi, Daniela</creatorcontrib><creatorcontrib>Verrotti, Alberto</creatorcontrib><creatorcontrib>Esposito, Susanna</creatorcontrib><title>Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?</title><title>International journal of environmental research and public health</title><addtitle>Int J Environ Res Public Health</addtitle><description>To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone⁻releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<-2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than -2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.</description><subject>Adolescent</subject><subject>Adults</subject><subject>Age</subject><subject>Arginine</subject><subject>Arginine - administration & dosage</subject><subject>Blood</subject><subject>Blood glucose</subject><subject>Blood levels</subject><subject>Body composition</subject><subject>Body fat</subject><subject>Body height</subject><subject>Bone mass</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cholesterol</subject><subject>Clonidine</subject><subject>Drug Monitoring - methods</subject><subject>Drug Monitoring - standards</subject><subject>Dwarfism, Pituitary - drug therapy</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Glucose</subject><subject>Glucose metabolism</subject><subject>Growth Hormone - therapeutic use</subject><subject>Growth hormone-releasing hormone</subject><subject>Growth Hormone-Releasing Hormone - administration & dosage</subject><subject>Growth hormones</subject><subject>High density lipoprotein</subject><subject>Homeostasis</subject><subject>Hormone Replacement Therapy - methods</subject><subject>Human Growth Hormone - blood</subject><subject>Human Growth Hormone - deficiency</subject><subject>Humans</subject><subject>Insulin</subject><subject>Insulin resistance</subject><subject>Insulin-Like Growth Factor I - metabolism</subject><subject>Insulin-like growth factors</subject><subject>Lipid metabolism</subject><subject>Lipids</subject><subject>Low density lipoprotein</subject><subject>Male</subject><subject>Males</subject><subject>Medical Overuse - prevention & control</subject><subject>Medicine</subject><subject>Metabolism</subject><subject>Muscle strength</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Physiology</subject><subject>Pituitary gland</subject><subject>Triglycerides</subject><issn>1660-4601</issn><issn>1661-7827</issn><issn>1660-4601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdUdFqFDEUDaLYuvrqowR8qQ9bk0mayfhQKW3dXSgouuJjyCR3OllnkzHJtOyX9HdNaS2t3MAN3HPOvYeD0FtKDhlryEe3gTj2VBBWqn6G9qkQZM4Foc8f_ffQq5Q2hDDJRfMS7TEiakmp3Ec3ixiuc4-XIW6DB3ywWH7A6x6iHnf4bIrOX-LcA15H7ZPLLnj8DaIL9hP-0YdpsPhXGfbO_8YnbZgyPtdx2OHvkCHlW7IrBJ0d-JzwtSubVtaFUefeGay9xasUBp3B4sUSn0HnTIGa3efX6EWnhwRv7vsM_fxyvj5dzi--LlanJxdzw6nMc9mSzlZUt9yImjEKXMrOaiqotJI3DZU1r2UrCDS6vJYyQwmDDqjh0jSCzdDxne44tVuwptwZ9aDG6LY67lTQTj2deNery3ClBJOSiaoIHNwLxPBnKqbV1iUDw6A9hCmpitYNP6oqWRfo-_-gmzBFX-ypilWyEUey5DhDh3coE0NKEbqHYyhRt5mrp5kXwrvHFh7g_0JmfwHl0KnY</recordid><startdate>20190123</startdate><enddate>20190123</enddate><creator>Penta, Laura</creator><creator>Cofini, Marta</creator><creator>Lucchetti, Laura</creator><creator>Zenzeri, Letizia</creator><creator>Leonardi, Alberto</creator><creator>Lanciotti, Lucia</creator><creator>Galeazzi, Daniela</creator><creator>Verrotti, Alberto</creator><creator>Esposito, Susanna</creator><general>MDPI AG</general><general>MDPI</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-4103-2837</orcidid></search><sort><creationdate>20190123</creationdate><title>Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?</title><author>Penta, Laura ; Cofini, Marta ; Lucchetti, Laura ; Zenzeri, Letizia ; Leonardi, Alberto ; Lanciotti, Lucia ; Galeazzi, Daniela ; Verrotti, Alberto ; Esposito, Susanna</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-8b0fd21ab4c67331e488fda1618d8499187478b60e9ae9ab13c103efe1c48c963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adults</topic><topic>Age</topic><topic>Arginine</topic><topic>Arginine - administration & dosage</topic><topic>Blood</topic><topic>Blood glucose</topic><topic>Blood levels</topic><topic>Body composition</topic><topic>Body fat</topic><topic>Body height</topic><topic>Bone mass</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cholesterol</topic><topic>Clonidine</topic><topic>Drug Monitoring - methods</topic><topic>Drug Monitoring - standards</topic><topic>Dwarfism, Pituitary - drug therapy</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Glucose</topic><topic>Glucose metabolism</topic><topic>Growth Hormone - therapeutic use</topic><topic>Growth hormone-releasing hormone</topic><topic>Growth Hormone-Releasing Hormone - administration & dosage</topic><topic>Growth hormones</topic><topic>High density lipoprotein</topic><topic>Homeostasis</topic><topic>Hormone Replacement Therapy - methods</topic><topic>Human Growth Hormone - blood</topic><topic>Human Growth Hormone - deficiency</topic><topic>Humans</topic><topic>Insulin</topic><topic>Insulin resistance</topic><topic>Insulin-Like Growth Factor I - metabolism</topic><topic>Insulin-like growth factors</topic><topic>Lipid metabolism</topic><topic>Lipids</topic><topic>Low density lipoprotein</topic><topic>Male</topic><topic>Males</topic><topic>Medical Overuse - prevention & control</topic><topic>Medicine</topic><topic>Metabolism</topic><topic>Muscle strength</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Physiology</topic><topic>Pituitary gland</topic><topic>Triglycerides</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Penta, Laura</creatorcontrib><creatorcontrib>Cofini, Marta</creatorcontrib><creatorcontrib>Lucchetti, Laura</creatorcontrib><creatorcontrib>Zenzeri, Letizia</creatorcontrib><creatorcontrib>Leonardi, Alberto</creatorcontrib><creatorcontrib>Lanciotti, Lucia</creatorcontrib><creatorcontrib>Galeazzi, Daniela</creatorcontrib><creatorcontrib>Verrotti, Alberto</creatorcontrib><creatorcontrib>Esposito, Susanna</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of environmental research and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Penta, Laura</au><au>Cofini, Marta</au><au>Lucchetti, Laura</au><au>Zenzeri, Letizia</au><au>Leonardi, Alberto</au><au>Lanciotti, Lucia</au><au>Galeazzi, Daniela</au><au>Verrotti, Alberto</au><au>Esposito, Susanna</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency?</atitle><jtitle>International journal of environmental research and public health</jtitle><addtitle>Int J Environ Res Public Health</addtitle><date>2019-01-23</date><risdate>2019</risdate><volume>16</volume><issue>3</issue><spage>307</spage><pages>307-</pages><issn>1660-4601</issn><issn>1661-7827</issn><eissn>1660-4601</eissn><abstract>To investigate growth hormone (GH) secretion at the transition age, retesting of all subjects who have undergone GH replacement therapy is recommended when linear growth and pubertal development are complete to distinguish between transitional and persistent GH deficiency (GHD). Early retesting of children with idiopathic and isolated GHD (i.e., before the achievement of final height and/or the adult pubertal stage) can avoid possible over-treatment. Here, we report data from our population with idiopathic and isolated GHD to encourage changes in the management and timing of retesting. We recruited 31 patients (19 males) with idiopathic GHD who received recombinant GH (rGH) for at least 2 years. All of the patients were retested at the transition age at least 3 months after rGH discontinuation. Permanent GHD was defined as a GH peak of <19 ng/mL after administration of growth hormone⁻releasing hormone (GHRH) + arginine as a provocative test. Permanent GHD was confirmed in only five of 31 patients (16.13%). None of these patients presented low serum insulin-like growth factor (IGF)-1 levels (<-2 standard deviation score (SDS)). Only one male patient with an IGF-1 serum level lower than -2 SDS showed a normal GH stimulation response, with a GH peak of 44.99 ng/mL. Few patients with idiopathic and isolated GHD demonstrated persistence of the deficit when retested at the transition age, suggesting that the timing of retesting should be anticipated to avoid overtreatment.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>30678118</pmid><doi>10.3390/ijerph16030307</doi><orcidid>https://orcid.org/0000-0003-4103-2837</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adolescent Adults Age Arginine Arginine - administration & dosage Blood Blood glucose Blood levels Body composition Body fat Body height Bone mass Child Child, Preschool Cholesterol Clonidine Drug Monitoring - methods Drug Monitoring - standards Dwarfism, Pituitary - drug therapy Endocrinology Female Glucose Glucose metabolism Growth Hormone - therapeutic use Growth hormone-releasing hormone Growth Hormone-Releasing Hormone - administration & dosage Growth hormones High density lipoprotein Homeostasis Hormone Replacement Therapy - methods Human Growth Hormone - blood Human Growth Hormone - deficiency Humans Insulin Insulin resistance Insulin-Like Growth Factor I - metabolism Insulin-like growth factors Lipid metabolism Lipids Low density lipoprotein Male Males Medical Overuse - prevention & control Medicine Metabolism Muscle strength NMR Nuclear magnetic resonance Physiology Pituitary gland Triglycerides |
| title | Growth Hormone (GH) Therapy During the Transition Period: Should We Think About Early Retesting in Patients with Idiopathic and Isolated GH Deficiency? |
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