Which Patients Do Not Require a GH Stimulation Test for the Diagnosis of Adult GH Defic... - 0 views
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Four studies have reported that the probability of GHD (peak GH criteria ranging from < 2.3 to < 5 μg/liter) in patients with three to four PHDs ranges from 91% to 100%
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95% accuracy by the presence of either three or more PHDs or a serum IGF-I concentration less than 84 μg/lite
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adult GHD could be predicted with 95% accuracy by the presence of either three or four PHDs or a serum IGF-I concentration less than 84 μg/liter
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Hypopituitary adults with GHD have been reported to have normal serum IGF-I levels in 37–70% of patients in various studies (5, 9, 18, 21, 22). This is owing in part to the fact that multiple factors regulate serum IGF-I concentrations including nutritional status; hepatic and renal function; and circulating concentrations of thyroid hormone, androgens, and estrogens
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changes in concentrations of IGF-binding proteins (IGFBPs) influence the total concentration of IGF-I in plasma
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Among patients with an IGF-I sd score above −1 in the present study, 46% had a peak GH less than 2.5 μg/liter and 67% had a peak GH less than 5 μg/liter.
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In summary, adult GHD can be predicted with 95% accuracy by the presence of either three or four PHDs or a serum IGF-I concentration less than 84 μg/liter
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We propose that adult patients with three or four PHDs (three or four of the following deficiencies: TSH, ACTH, gonadotropins [LH and/or FSH], and AVP [central diabetes insipidus]) do not require a GH stimulation test to make the diagnosis of adult GHD