Styne Dennis M
Department of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA 95817, USA.
J Pediatr Endocrinol Metab. 2003 May;16 Suppl 3:637-43.
To establish the diagnosis of adult growth hormone deficiency (GHD), GH-deficient children transitioning to adulthood are evaluated by two separate stimuli 2 or more weeks after ceasing GH therapy. While 20-88% of children diagnosed with idiopathic GHD retest with normal values, those with proven genetic defects in GH production/secretion/bioactivity and patients with panhypopituitarism consistently test deficient. The US Food and Drug Administration (FDA) defines GHD in adults by stimulated peak serum GH concentrations <5 ng/ml if measured by polyclonal radioimmunoassays (RIA) or lower if measured by monoclonal assays. Some investigators define severe GHD by a peak GH concentration <3 ng/ml. Adult responses to arginine and glucagon testing are similar to the responses to insulin tolerance testing; clonidine, pyridostigmine, and galanin cause lesser peaks of GH. Growth hormone-releasing hormone (GHRH) combined with arginine, GH releasing peptide-6 (GHRP-6), or hexarelin leads to higher peak responses than GHRH alone. Thus the choice of testing methods impacts the diagnosis of GHD in transition patients.
为了确立成人生长激素缺乏症（GHD）的诊断，停止生长激素治疗2周或更长时间后，对从儿童期过渡到成人期的生长激素缺乏儿童进行两种独立刺激试验评估。虽然20%-88%被诊断为特发性生长激素缺乏症的儿童复查时结果正常，但那些已证实生长激素产生/分泌/生物活性存在基因缺陷的儿童以及全垂体功能减退患者复查结果始终为缺乏。美国食品药品监督管理局（FDA）规定，采用多克隆放射免疫测定法（RIA）检测时，成人血清生长激素刺激峰值浓度<5 ng/ml可诊断为生长激素缺乏症；若采用单克隆测定法，诊断标准则更低。一些研究人员将生长激素峰值浓度<3 ng/ml定义为严重生长激素缺乏症。成人对精氨酸和胰高血糖素试验的反应与对胰岛素耐量试验的反应相似；可乐定、吡啶斯的明和甘丙肽引起的生长激素峰值较低。生长激素释放激素（GHRH）联合精氨酸、生长激素释放肽-6（GHRP-6）或六肽生长激素释放肽导致的峰值反应高于单独使用GHRH。因此，检测方法的选择会影响过渡患者生长激素缺乏症的诊断。
