Andersen Marianne
Department of Endocrinology, Odense University Hospital, University of Southern Denmark, Kløvervænget 6, 5000 Odense C, Denmark.
Growth Horm IGF Res. 2015 Jun;25(3):108-14. doi: 10.1016/j.ghir.2015.03.001. Epub 2015 Apr 7.
Since the 1970s, GH treatment has been an important tool in paediatric endocrinology for the management of growth retardation. It is now accepted that adults with severe GH deficiency (GHD) demonstrate impaired physical and psychological well-being and may benefit from replacement therapy with recombinant human GH. There is, however, an ongoing debate on how to diagnose GHD, especially in adults. A GH response below the cut-off limit of a GH-stimulation test is required in most cases for establishing GHD in adults. No 'gold standard' GH-stimulation test exists, but some GH stimulation tests may be more robust to variations in patient characteristics such as age and gender, as well as to pre-test conditions like heat exposure due to a hot bath or bicycling. However, body mass index (BMI) is negatively associated with GH-responses to all available GH-stimulation tests and glucocorticoid treatment, including conventional substitution therapy, influences the GH-responses. Recently, the role of IGF-I measurements in the clinical decision making has been discussed. The aim of this review is to discuss the available GH-stimulation tests. In this author's opinion, tests which include growth-hormone-releasing hormone (GHRH) tend to be more potent and robust, especially the GHRH+arginine test which has been proven to be of clinical use. In contrast, the insulin tolerance test (ITT) and the glucagon test appear to have too many drawbacks.
自20世纪70年代以来，生长激素（GH）治疗一直是儿科内分泌学中治疗生长迟缓的重要手段。目前人们公认，患有严重生长激素缺乏症（GHD）的成年人身心健康受损，可能会从重组人生长激素替代治疗中获益。然而，关于如何诊断生长激素缺乏症，尤其是在成年人中，目前仍存在争议。在大多数情况下，成年人确诊生长激素缺乏症需要生长激素刺激试验的反应低于临界值。目前不存在“金标准”的生长激素刺激试验，但某些生长激素刺激试验可能对患者特征（如年龄和性别）的变化以及诸如热水浴或骑自行车导致的热暴露等试验前条件的变化更具稳健性。然而，体重指数（BMI）与所有可用的生长激素刺激试验的生长激素反应呈负相关，并且糖皮质激素治疗（包括传统替代疗法）会影响生长激素反应。最近，胰岛素样生长因子-I（IGF-I）测量在临床决策中的作用也得到了讨论。本综述的目的是讨论现有的生长激素刺激试验。在作者看来，包含生长激素释放激素（GHRH）的试验往往更有效且更稳健，尤其是已被证明具有临床应用价值的GHRH+精氨酸试验。相比之下，胰岛素耐量试验（ITT）和胰高血糖素试验似乎存在太多缺点。
