SSD Endocrinologia Pediatrica e Centro Screening Neonatale, Ospedale Pediatrico Microcitemico "A. Cao", AO Brotzu, Cagliari, Italy.
Dipartimento di Pediatria, Università Federico II, Napoli, Italy.
Clin Endocrinol (Oxf). 2018 Dec;89(6):765-770. doi: 10.1111/cen.13845. Epub 2018 Sep 25.
The diagnosis of growth hormone deficiency (GHD) is currently based on clinical, auxological, biochemical and neuro-radiological investigation. Provocative tests of GH secretion using physiological/pharmacological stimuli are required to confirm GHD. The clonidine test (CT) is widely used to assess GH secretory status. In this retrospective study, we analyzed the reliability of CT and the effect of puberty in a large number of children with short stature who had been evaluated for suspected GHD.
Data were collected retrospectively from 327 children and adolescents with short stature (204 boys and 123 girls, median age 10.5 years (IQR 7.90-12.40) followed in four Italian Paediatric Endocrine Units (Cagliari, Genova, Napoli and Roma) between 2005 and 2013.
All children underwent CT as the first GH stimulation test after exclusion of other known cause of their short stature.
In 73 prepubertal children and 25 pubertal children, the GH peak after CT was <7 μg/L. GHD was confirmed in 87 (37 organic, 50 idiopathic). Six prepubertal and five pubertal patients showed false positive responses. The median BMI-SDS in these children was similar to that of children with GH peak ≥7 μg/L, and none were obese. Overall, the prevalence of false-positive responses was 3.3%. The median (IQR) peak GH after CT was similar between prepubertal and pubertal GHD (3.80 μg/L [1.7-6.00] vs 3.51 μg/L [0.76-5.74]) and non-GHD (13.70 μg/L [10.70-18.40] vs 12.40 μg/L [9.90-19.25]) children.
Our results show that CT is a reliable and safe GH-releasing agent in both prepubertal and pubertal children.
生长激素缺乏症（GHD）的诊断目前基于临床、生长发育、生化和神经放射学检查。需要使用生理/药理学刺激物进行 GH 分泌的激发试验来确认 GHD。可乐定试验（CT）广泛用于评估 GH 分泌状态。在这项回顾性研究中，我们分析了 CT 的可靠性以及青春期对大量疑似 GHD 矮小儿童 GH 分泌状态的影响。
数据从 2005 年至 2013 年在意大利四个儿科内分泌科（卡利亚里、热那亚、那不勒斯和罗马）就诊的 327 名身材矮小的儿童和青少年（204 名男孩和 123 名女孩，中位年龄 10.5 岁（IQR 7.90-12.40））中回顾性收集。
所有儿童在排除其他已知矮小原因后，均接受 CT 作为首次 GH 刺激试验。
在 73 名青春期前儿童和 25 名青春期儿童中，CT 后 GH 峰值<7μg/L。87 例（37 例为器质性，50 例为特发性）被确诊为 GHD。6 名青春期前儿童和 5 名青春期儿童出现假阳性反应。这些儿童的 BMI-SDS 中位数与 GH 峰值≥7μg/L 的儿童相似，且均非肥胖。总的来说，假阳性反应的发生率为 3.3%。青春期前和青春期 GHD（3.80μg/L[1.7-6.00]与 3.51μg/L[0.76-5.74]）和非 GHD（13.70μg/L[10.70-18.40]与 12.40μg/L[9.90-19.25]）儿童 CT 后 GH 峰值中位数（IQR）相似。
我们的结果表明，CT 是一种在青春期前和青春期儿童中均可靠且安全的 GH 释放剂。
