Gonc E Nazli, Kandemir Nurgun, Ozon Alev, Alikasifoglu Ayfer
Department of Pediatric Endocrinology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
J Pediatr Endocrinol Metab. 2008 Oct;21(10):963-71. doi: 10.1515/jpem.2008.21.10.963.
Priming with sex steroids prior to growth hormone (GH) stimulation tests for the diagnosis of GH deficiency is still debatable. We analyzed the auxological data of boys with growth retardation who had normal GH responses to stimulation tests only after priming to establish the validity of priming in the diagnosis of GH deficiency. We also analyzed the effect of different protocols for priming and their efficiency in the diagnosis of GH deficiency. Fifty boys with growth retardation who failed to respond to unprimed GH stimulation tests but responded normally to primed tests were included in the study. Thirty-one of 50 boys responded to GH stimulation tests after single low dose testosterone, 11/50 boys after single conventional dose, and 8/50 boys with multiple-dose testosterone. The study group was followed till final height; height velocity, final height and height SDS were compared to parental and mid-parental heights to determine whether or not the children achieved their height potential. Mean final height SDS of the study group (-1.27 +/- 0.72 SDS) was similar to mid-parental (-1.38 +/- 0.72 SDS) (p = 0.249) and maternal height SDS (-1.26 +/- 1.05 SDS) (p = 0.941), whereas it was greater than the paternal height SDS (-1.7 +/- 0.86) (p = 0.001). The final height SDS of the study group was correlated to maternal, paternal and mid-parental height SDS. Height velocity after the test was greater than the previous height velocity. Final height SDS of the boys who responded to the GH stimulation tests with different priming protocols were compared and found to be similar. Normal responders in primed GH tests grow normally to their target height, suggesting that priming might be a valuable method in the assessment of GH status. Use of priming in the GH stimulation tests of peripubertal boys with decreased growth rate may help avoid unnecessary GH therapy. Multiple-dose testing might exclude GHD in a patient population who failed to respond to a single dose of testosterone. This finding suggests that multiple-dose testosterone might be a more valuable method for priming in the differentiation of normal from abnormal GH secretion.
在生长激素（GH）刺激试验前使用性类固醇进行预处理以诊断GH缺乏症仍存在争议。我们分析了生长迟缓男孩的生长学数据，这些男孩仅在预处理后对刺激试验有正常的GH反应，以确定预处理在诊断GH缺乏症中的有效性。我们还分析了不同预处理方案的效果及其在诊断GH缺乏症中的效率。50名生长迟缓且对未预处理的GH刺激试验无反应但对预处理试验反应正常的男孩被纳入研究。50名男孩中，31名在单次低剂量睾酮后对GH刺激试验有反应，11/50名男孩在单次常规剂量后有反应，8/50名男孩在多次剂量睾酮后有反应。研究组随访至最终身高；将身高速度、最终身高和身高标准差与父母及父母平均身高进行比较，以确定儿童是否达到其身高潜力。研究组的平均最终身高标准差（-1.27±0.72标准差）与父母平均身高（-1.38±0.72标准差）（p = 0.249）和母亲身高标准差（-1.26±1.05标准差）（p = 0.941）相似，而大于父亲身高标准差（-1.7±0.86）（p = 0.001）。研究组的最终身高标准差与母亲、父亲及父母平均身高标准差相关。试验后的身高速度大于之前的身高速度。比较了用不同预处理方案对GH刺激试验有反应的男孩的最终身高标准差，发现相似。预处理GH试验中的正常反应者正常生长至其目标身高，这表明预处理可能是评估GH状态的一种有价值的方法。在生长速度下降的青春期前男孩的GH刺激试验中使用预处理可能有助于避免不必要的GH治疗。多次剂量试验可能会在对单剂量睾酮无反应的患者群体中排除生长激素缺乏症（GHD）。这一发现表明，多次剂量睾酮可能是在区分正常与异常GH分泌的预处理中更有价值的方法。
