Diagnosing Growth Hormone Deficiency in Adults - 0 views
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it is clear that serum IGF-1 and or IGFBP-3 can be normal in patients with undisputed GHD
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The co-administration of arginine and GHRH (the combined test) is a powerful stimulus for GH production and has gained increasing acceptance as a useful method of diagnosing GHD [34]. This test has been advocated as a suitable alternative to ITT
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The glucagon stimulation test (GST) is a reliable, safe alternative to the ITT in the diagnosis of GHD
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An intravenous infusion of arginine (0.5 g/kg body weight) together with an intravenous bolus of GHRH (1 mcg/kg body weight) is administered [30]. Serum samples for GH are then obtained every 15–30 minutes for two hours.
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Obesity, particularly marked obesity, is associated with blunted GH secretion in response to provocative stimuli
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It has also been suggested that that even mildly increased BMI (25–30 kg/m2) can result in diminished stimulated GH production in 13% of healthy subjects
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Corneli et al. have defined BMI-specific cut-off points for diagnosing adult-onset GHD using GHRH + arginine—11.5 ng/mL for those with BMI < 25 kg/m2, 8.0 ng/mL for BMI 25–30 kg/m2, 4.2 ng/mL for those with BMI > 30 kg/m2
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Oral, in contrast to transdermal oestrogen, lowers IGF-1 levels and is associated with increased GH levels
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Adequate pituitary replacement with thyroxine and hydrocortisone are needed for optimal GH production
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Numerous GH secretagogues are available with the insulin tolerance test being the gold standard and the glucagon stimulation test or the GHRH + arginine as acceptable alternatives
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the GST is safe, with almost no contraindications, it causes nausea and sometimes vomiting in 15–20% of subjects