Loche Sandro, Bizzarri Carla, Maghnie Mohamad, Faedda Antonella, Tzialla Chryssoula, Autelli Michele, Casini Maria Rosaria, Cappa Marco
Servizio di Endocrinologia Pediatrica, Ospedale Regionale per le Microcitemie, Cagliari, Clinica Pediatrica, Servizio Analisi Chimico Cliniche, IRCCS Policlinico San Matteo, Università di Pavia, Italy.
J Pediatr. 2002 Apr;140(4):445-9. doi: 10.1067/mpd.2002.122729.
To test the hypothesis that normalization of the growth hormone (GH) response to stimulation in patients with GH deficiency (GHD) and normal magnetic resonance imaging (MRI) of the hypothalamic-pituitary area might occur earlier than at attainment of final height.
Prepubertal children with short stature (21 boys and 12 girls; age, 5.2-10 years), in whom a diagnosis of GHD was based on a GH response <10 microg/L after 2 pharmacologic tests (clonidine, arginine, or insulin hypoglycemia), and normal MRI of the hypothalamic-pituitary area were studied. After 1 to 6 months, all children underwent reevaluation of GH secretion by means of one of the provocative tests previously used. During that time, none of the children received GH therapy or entered puberty.
A GH response > or =10 microg/L after retesting was found in 28 patients, and a GH response <10 microg/L was found in 5. In 9 patients, the peak GH response at diagnosis was <7 microg/L to both tests used. In 8, the GH response at retesting was > or =10 microg/L and was 9.0 microg/L in the remaining child.
We suggest that patients with pathologic GH responses to provocative tests but normal MRI should be reevaluated and followed up before a diagnosis of GHD is firmly established.
检验以下假设，即生长激素缺乏症（GHD）患者且下丘脑 - 垂体区域磁共振成像（MRI）正常，其对刺激的生长激素（GH）反应正常化可能比达到最终身高的时间更早出现。
对青春期前身材矮小的儿童（21名男孩和12名女孩；年龄5.2 - 10岁）进行研究，这些儿童中GHD的诊断基于两次药物测试（可乐定、精氨酸或胰岛素低血糖）后GH反应<10μg/L且下丘脑 - 垂体区域MRI正常。1至6个月后，所有儿童通过之前使用的一种激发试验重新评估GH分泌情况。在此期间，没有儿童接受GH治疗或进入青春期。
重新测试后，28名患者的GH反应≥10μg/L，5名患者的GH反应<10μg/L。9名患者在诊断时对所使用的两种测试的GH峰值反应均<7μg/L。8名患者重新测试时的GH反应≥10μg/L，其余1名儿童的GH反应为9.0μg/L。
我们建议，对于对激发试验有病理性GH反应但MRI正常的患者，在明确诊断GHD之前应进行重新评估和随访。
