A Survey of Growth Hormone Stimulation Test Efficacy for Workup of Short Stature in a Referral Laboratory

Article Information

Title: A Survey of Growth Hormone Stimulation Test Efficacy for Workup of Short Stature in a Referral Laboratory

Authors: Muhammad Usman Munir, Muhammad Aamir, Zujaja Hina Haroon, Sobia Irum Kirmani, Afshan Yasir, Hunain Habib

Journal: Pakistan Armed Forces Medical Journal (PAFMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2021-07-01	2022-06-30
Y	2020-07-01	2021-06-30
Y	1900-01-01	2005-06-30

Publisher: Army Medical College, Rawalpindi.

Country: Pakistan

Year: 2023

Volume: 73

Issue: 2

Language: English

DOI: 10.51253/pafmj.v73i2.7906

Keywords: Growth hormone stimulation testsShort statureHeight percentile

Abstract

Objective: To assess growth hormone (GH) stimulation test efficacy in short stature workup for establishing GH deficiency.
Study Design: Cross-sectional survey.
Place and Duration of Study: Diagnostic Endocrine Section, Department of Chemical Pathology &amp; Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Aug 2020 to Jan 2021.
Methodology: The study was conducted on 129 individuals aged 2-16 years. History, axiological data and biochemical parameters were assessed to establish GH deficiency for short stature workup.
Results: Out of 129 individuals, 76(59%) boys and 53(41%) girls reported GH stimulation tests. 81(62.3%) children were in &lt;3rd percentile, 29(22.3%) in &lt;5th percentile, 9(6.9%) in &lt;10th percentile and 5(3.8%) in &lt;25th percentile. Among the group with bone age difference &gt;2 years, 34(82.9%) fell in &lt;3rd percentile. GH Stimulation test post-Levo Dopa was performed in 102(78.46%) patients. 49(37.4%) patients responded inadequately to the GH stimulation test. The adequate response to the GH Stimulation test improved as the percentile declined from the 50th to the 3rd percentile.
Conclusion: GH stimulation test results can only partially rely upon though their importance remains in combination with other short-stature workup parameters for ruling out growth hormone deficiency.&nbsp;

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Research Objective

To assess the efficacy of growth hormone (GH) stimulation tests in the workup of short stature for establishing GH deficiency.

Methodology

A cross-sectional survey was conducted at the Diagnostic Endocrine Section, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from August 2020 to January 2021. Data from 129 individuals aged 2-16 years undergoing GH stimulation tests for short stature workup were analyzed. This included history, axiological data (age, gender, height percentile, bone age difference, consanguinity, failure to thrive, developmental delay), and biochemical parameters (Hb, calcium, ALP, TSH, cortisol, GH, IGF-1, IGFBP-3, Anti-TTG Ab). GH stimulation tests (Post Levo Dopa and Post-exercise) and Insulin Tolerance Test (ITT) were performed. Statistical analysis was done using SPSS version 23.0.

Methodology Flowchart

                        graph TD
    A["Data Collection: History, Axiological Data, Biochemical Parameters"] --> B["GH Stimulation Tests: Levo Dopa, Exercise, ITT"]
    B --> C["Data Analysis: SPSS"]
    C --> D["Interpretation of Results"]
    D --> E["Conclusion"]

Discussion

The study highlights that GH stimulation test results alone are not definitive for diagnosing GH deficiency and should be interpreted in conjunction with other parameters. Early GH workup was observed more in females than males. Bone age determination is crucial, as a significant bone age difference (>2 years) was associated with a higher incidence of inadequate GH stimulation test responses. IGF-1 and IGFBP-3 tests were underutilized. The study also notes the infrequent use of ITT and the lack of standardized protocols, including sex priming and national growth charts, which are needed for accurate diagnosis and treatment.

Key Findings

- Out of 129 individuals, 76 (59%) were boys and 53 (41%) were girls.
- 81 (62.3%) children were below the 3rd percentile for height.
- Among those with a bone age difference >2 years, 82.9% were below the 3rd percentile.
- 49 (37.4%) patients responded inadequately to the GH stimulation test.
- Adequate response to GH stimulation tests improved as the height percentile declined from the 50th to the 3rd percentile.
- GH stimulation test response post-Levo Dopa was more pronounced (33.4±18.78 nmol/L) than post-exercise (23.83±3.0 nmol/L).

Conclusion

Growth hormone stimulation tests have varied responses and should be used in combination with other short-stature workup parameters to rule out growth hormone deficiency.

Fact Check

- The study included 129 individuals aged 2-16 years. (Confirmed in Methodology)
- 81 (62.3%) children were in the <3rd percentile for height. (Confirmed in Results)
- 49 (37.4%) patients responded inadequately to the GH stimulation test. (Confirmed in Results)

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