Clinical, Biochemical and Neuroimaging Findings as Predictors of Growth Hormone Deficiency (GHD) in paediatric patients

CLÉMENT F; KESELMAN A; MARTINEZ A; ROPELATO M; BALLERINI MG; GRINSPON R; BRASLAVSKY D; BERGADÁ I; REY R; FINKELSTAIN G

Purto Varas

Congreso; XXV Annual Meeting SLEP; 2015

Sociedad Latinoamericana de Endocrinología Pediátrica

Background: Growth hormone provocation tests (GHPT) have been used as a standard diagnostic tool in patients with clinical and biochemical criteria suggestive of GHD. However, these tests are invasive, need a standardized protocol, should be care fully monitored by an experienced team and may raise safety issues, especially in a child with co-morbidities. Previous studies aiming to identify risk factors for GHD do not include specific known phenotypes and/or clinical findings that could anticipate GHD. Objective: To identify risk factors that might predict with high accuracy the presence GHD in children eligible for GHPT. Patients and Methods: Case-control retrospective study, with clinical chart review of all patients meeting the criteria for GHPT between 2005 and 2014. Results: Seventy-three out of 364 patients who underwent GHPT had GHD. The presence of history of sellar and/or suprasellar region surgery, one or more anterior pituitary deficiency associated with diabetes insipidus, hypogenitalism in males, neonatal hypoglycaemia or cholestasis, craniofacial midline defects or pituitary dysgenesis by imaging studies showed a positive predictive value of 100% (IC 95% 0.83 to 1.00) to diagnose GHD. Using this proposed group of risk factors in our study population, 21 patients could have been identified as GHD without GHPT (28.8% of GHD patients). There was a strong association between GHD and the existence of at least one of the postulated risk factors (Fisher?s exact test P < 0.0001). The odds ratio for having a risk factor was 238.8-fold higher (95% CI 14.2 to 4005) in the GHD group. Conclusions: We identified a group of risk factors that predicted GHD with high accuracy. Therefore, in patients with these risk factors, performing GHPT would not be necessary to confirm the diagnosis of GHD.