Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.
Neuroendocrinology. 2011;93(4):259-64. doi: 10.1159/000326838. Epub 2011 Apr 1.
The diagnosis of growth hormone (GH) deficiency is based on a reduced peak GH response to provocative tests. However, the provocative tests are poorly reproducible and GH secretion is regulated by physiological parameters, such as body weight and puberty. The aim of this study was to assess the influence of body mass index (BMI) on GH response to provocative testing and to analyze the reproducibility of GH stimulation test.
Clinical data were collected retrospectively by chart review from the Pediatric Endocrine Unit at the Ajou University Hospital. A total of 187 subjects with short stature who completed a GH stimulation testing between 2003 and 2009 were included in the study.
Of the 187 subjects, 66 (35.3%) had GH deficiency, while 121 (64.7%) were categorized as having idiopathic short stature. Reliability was calculated for 48 patients with idiopathic short stature who underwent the GH stimulation test twice. A GH response ≥10 ng/ml after retesting was found in 39 patients (81.3%) and a GH response <10 ng/ml was found in 9 patients (18.7%). In a stepwise multivariate analysis, BMI was a significantly independent predictor of peak GH. Elevated BMI was negatively associated with peak plasma GH levels.
The lack of reliability of GH values in response to pharmacological stimuli should be taken into account in the diagnosis of GH deficiency. Also, higher BMI is associated with lower GH secretion. BMI should be measured and GH results appropriately interpreted for all subjects undergoing GH stimulation testing.
生长激素（GH）缺乏症的诊断基于对激发试验的 GH 反应降低。然而，激发试验的重复性较差，并且 GH 分泌受到生理参数的调节，例如体重和青春期。本研究的目的是评估 BMI 对激发试验中 GH 反应的影响，并分析 GH 刺激试验的可重复性。
通过回顾性图表审查，从亚洲大学附属医院儿科内分泌科收集临床数据。共纳入 187 例 2003 年至 2009 年间完成 GH 刺激试验的身材矮小患者。
在 187 例患者中，有 66 例（35.3%）存在 GH 缺乏症，而 121 例（64.7%）归类为特发性身材矮小症。对 48 例特发性身材矮小症患者进行了两次 GH 刺激试验的可靠性进行了计算。在 39 例（81.3%）患者中，在重新测试后 GH 反应≥10ng/ml，在 9 例（18.7%）患者中 GH 反应<10ng/ml。在逐步多元分析中，BMI 是 GH 峰值的显著独立预测因子。较高的 BMI 与较高的血浆 GH 水平呈负相关。
在诊断 GH 缺乏症时，应考虑到药物刺激下 GH 值缺乏可靠性。此外，较高的 BMI 与较低的 GH 分泌有关。应测量 BMI，并对所有接受 GH 刺激试验的患者进行适当的 GH 结果解读。
