Operative Unit of Endocrinology, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Endocr Metab Immune Disord Drug Targets. 2021;21(8):1406-1412. doi: 10.2174/1871530320666200929141847.
Adult growth hormone deficiency (GHD) is considered a rare condition. Current guidelines state that GH provocative test is indicated in patients affected by organic hypothalamic/ pituitary disease or with a history of head injury, irradiation, hemorrhage or hypothalamic disease with multiple pituitary deficiencies. Nevertheless, the clinical picture related to GHD may be subtle.
We have retrospectively evaluated the indication to GHRH+arginine test in our monocentric cohort of patients treated with hrGH in order to assess whether other conditions had been considered as a rationale for provocative testing.
Ninety-six patients (51 females and 45 males), aged 19-67 years were included. The GHRH+arginine test had been performed in 29 patients with organic hypothalamic/pituitary disease and in 4 patients for Childhood onset-GHD (CoGHD). In other patients, the diagnosis was suspected for "non classical" reasons in the clinical picture suspected for GHD.
Classical indications included previously known primary empty sella (n=15), pituitary surgery (n=14), pituitary cyst (n=1), non-secreting pituitary tumors (n=3) but more than half of the patients (57.3%) had been studied for "non classical" indications: metabolic syndrome (n=25), asthenia (n=13), heart failure (n=4), osteoporosis (n=6), unexplained hypoglycaemia (n=1) and infertility (n=6). The latter represented a significant percentage in the male subgroup under 45 ys. IGF-1 levels were lower than 50th percentile in 63% of patients. Finally, among non-classical reasons, organic pituitary disease was discovered in 22 patients.
Idiopathic GHD may be unrecognized due to its subtle manifestations and that an extended use of dynamic GH tests may reveal such conditions. A potential field of investigation could be to identify subsets of patients with clinical conditions caused or worsened by underlying unrecognized GHD.
成人生长激素缺乏症（GHD）被认为是一种罕见的疾病。目前的指南指出，生长激素兴奋试验适用于患有器质性下丘脑/垂体疾病或有头部外伤、放疗、出血或下丘脑疾病伴多种垂体功能减退病史的患者。然而，GHD 相关的临床表现可能较为微妙。
我们回顾性评估了在接受 rhGH 治疗的单中心患者队列中进行 GHRH+精氨酸试验的指征，以评估是否存在其他情况被认为是进行激发试验的合理理由。
共纳入 96 例患者（51 名女性和 45 名男性），年龄 19-67 岁。29 例患者因器质性下丘脑/垂体疾病而进行 GHRH+精氨酸试验，4 例患者因儿童期起病的 GHD（CoGHD）而进行该试验。在其他患者中，由于怀疑存在 GHD 可疑临床表现的“非典型”原因而做出诊断。
经典的指征包括先前已知的原发性空蝶鞍（n=15）、垂体手术（n=14）、垂体囊肿（n=1）、无分泌功能的垂体肿瘤（n=3），但超过一半的患者（57.3%）因“非典型”指征而接受了检查：代谢综合征（n=25）、乏力（n=13）、心力衰竭（n=4）、骨质疏松症（n=6）、不明原因的低血糖（n=1）和不孕（n=6）。在 45 岁以下的男性亚组中，后者占很大比例。63%的患者 IGF-1 水平低于第 50 百分位。最后，在非典型原因中，22 例患者发现了器质性垂体疾病。
由于其表现较为微妙，可能会导致特发性 GHD 被忽视，而广泛应用生长激素动态试验可能会发现此类情况。一个潜在的研究领域可能是确定具有潜在未被识别的 GHD 导致或加重的临床疾病的患者亚组。
