Chemaitilly W, Trivin C, Souberbielle J-C, Brauner R
Université René-Descartes and Pediatric Endocrinology Unit, Hôpital Necker-Enfants-Malades, Assistance Publique-Hôpitaux de Paris, France.
Horm Res. 2003;60(1):34-42. doi: 10.1159/000070825.
To optimize the workup of short-statured children by defining the most appropriate tools for diagnosing growth hormone (GH) deficiency.
Patients were assigned to prepubertal (n = 113) or pubertal (n = 112, including 25 boys primed with testosterone) age groups. Mean plasma GH concentration during sleep, GH peak after provocative test, and insulin-like growth factor I (IGF-I) were measured in a single evaluation.
The mean GH concentration during sleep was more often normal (n = 155) than the GH peak after provocative tests (n = 105) or the IGF-I concentration (n = 88). Prepubertal patients with a normal body mass index (BMI) had mean GH concentrations during sleep that correlated positively with height, growth rate, GH peak after provocative tests, and IGF-I (p < 0.0005 for all) and negatively with the difference between target and patient heights (p = 0.01) and BMI (p < 0.05). Pubertal patients with a normal BMI had a mean GH concentration during sleep that correlated positively with GH after provocative tests (p < 0.0001) and IGF-I (p < 0.005). Mean GH concentration during sleep and IGF-I concentration for boys primed with testosterone were more often normal (n = 23) than the GH peak after provocative tests (n = 14). All 9 patients with pituitary stalk interruption had low IGF-I concentrations; 1 patient had a normal GH peak after provocative test, and 2 patients had normal mean GH concentrations during sleep.
Measuring the GH concentration during sleep and priming boys with pubertal delay can help to exclude idiopathic GH deficiency. Magnetic resonance imaging is needed to exclude anatomic abnormalities when GH and/or IGF-I concentrations are low.
通过确定诊断生长激素（GH）缺乏症的最合适工具，优化身材矮小儿童的检查流程。
将患者分为青春期前（n = 113）或青春期（n = 112，包括25名接受睾酮激发的男孩）年龄组。在单次评估中测量睡眠期间的平均血浆GH浓度、激发试验后的GH峰值以及胰岛素样生长因子I（IGF-I）。
睡眠期间的平均GH浓度正常的情况（n = 155）比激发试验后的GH峰值（n = 105）或IGF-I浓度（n = 88）更为常见。青春期前体重指数（BMI）正常的患者，睡眠期间的平均GH浓度与身高、生长速率、激发试验后的GH峰值以及IGF-I呈正相关（所有p < 0.0005），与目标身高和患者身高的差值呈负相关（p = 0.01），与BMI呈负相关（p < 0.05）。青春期BMI正常的患者，睡眠期间的平均GH浓度与激发试验后的GH（p < 0.0001）和IGF-I（p < 0.005）呈正相关。接受睾酮激发的男孩，睡眠期间的平均GH浓度和IGF-I浓度正常的情况（n = 23）比激发试验后的GH峰值正常的情况（n = 14）更为常见。所有9例垂体柄中断患者的IGF-I浓度均较低；1例患者激发试验后的GH峰值正常，2例患者睡眠期间的平均GH浓度正常。
测量睡眠期间的GH浓度以及对青春期延迟的男孩进行激发试验有助于排除特发性GH缺乏症。当GH和/或IGF-I浓度较低时，需要进行磁共振成像以排除解剖学异常。
