Bercu B B, Walker R F
Department of Pediatrics, University of South Florida College of Medicine, All Children's Hospital, St Petersburg, USA.
Acta Paediatr Suppl. 1997 Nov;423:102-6. doi: 10.1111/j.1651-2227.1997.tb18385.x.
A diagnostic test was devised to evaluate pituitary growth hormone (GH) secretory potential. GH secretory dynamics were assessed in children with and without GH deficiency. The GH response was measured to GH-releasing hormone (GHRH) and the GH-releasing peptide GHRP-2, administered sequentially. The mean (+/- SEM) peak GH response to GHRP-2 was 20.1 +/- 5.5, 63.6 +/- 24.9 and 42.2 +/- 4.3 micrograms/l for GH-deficient, slowly growing non-GH-deficient and control children, respectively (p < 0.02 and p < 0.05 for GH-deficient vs controls and slowly growing children, respectively). Corresponding values for area under the curve (AUC) were 995 +/- 371. 2460 +/- 953 and 1598 +/- 274 micrograms/l x minute. Peak GH (and AUC) responses to GHRH were 19.6 +/- 5.1 micrograms/l (924 +/- 232 micrograms/l x minute), 31.4 +/- 8.4 micrograms/l (1544 +/- 449 micrograms/l x minute) and 39.8 +/- 7.8 micrograms/l (2201 +/- 437 micrograms/l x minute) for the same three groups, respectively (p < 0.05 for peak GH in GH-deficient patients vs controls, and p < 0.02 and p < 0.01 for AUC in GH-deficient vs slowly growing children and controls, respectively). The ratio of the peak GH response to GHRP-2 and GHRH was similar in all three groups. As these secretagogues stimulate different aspects of hypothalamic function (i.e., they are functional complements), robust GH secretion in response to GHRH or GHRP could suggest adequate endogenous GHRP or GHRH, respectively. A poor response to either GH secretagogue administered individually could represent inadequacy of its endogenous complement. The integrity of functional pituitary elements could be differentiated from inadequate complements by administering both GH secretagogues simultaneously. Application of these principles should allow a better definition of the underlying disorder and provide the basis for therapeutic strategies for those patients with abnormal GH production and/or secretion.
设计了一种诊断测试来评估垂体生长激素（GH）的分泌潜能。对有和没有GH缺乏症的儿童评估了GH分泌动态。依次给予生长激素释放激素（GHRH）和生长激素释放肽GHRP-2后测量GH反应。GH缺乏症儿童、生长缓慢的非GH缺乏症儿童和对照儿童对GHRP-2的平均（±SEM）峰值GH反应分别为20.1±5.5、63.6±24.9和42.2±4.3微克/升（GH缺乏症儿童与对照儿童以及生长缓慢儿童相比，p分别<0.02和p<0.05）。曲线下面积（AUC）的相应值分别为995±371、2460±953和1598±274微克/升×分钟。相同三组对GHRH的峰值GH（和AUC）反应分别为19.6±5.1微克/升（924±232微克/升×分钟）、31.4±8.4微克/升（1544±449微克/升×分钟）和39.8±7.8微克/升（2201±437微克/升×分钟）（GH缺乏症患者与对照儿童的峰值GH相比，p<0.05；GH缺乏症患者与生长缓慢儿童和对照儿童的AUC相比，p分别<0.02和p<0.01）。三组中GHRP-2与GHRH的峰值GH反应比值相似。由于这些促分泌素刺激下丘脑功能的不同方面（即它们是功能互补物），对GHRH或GHRP有强烈的GH分泌反应可能分别提示内源性GHRP或GHRH充足。对单独给予的任何一种GH促分泌素反应不佳可能代表其内源性互补物不足。通过同时给予两种GH促分泌素，可以将功能性垂体成分的完整性与不足的互补物区分开来。应用这些原则应该能够更好地定义潜在疾病，并为那些GH产生和/或分泌异常的患者提供治疗策略的基础。
