Clinical, biochemical and neuroimaging findings as predictors of growth hormone deficiency (GHD) in children

CLÉMENT, F.; BRASLAVSKY, D.; KESELMAN, A.; MARTÍNEZ, A.; ROPELATO, M.G.; BALLERINI, M.G.; BERGADÁ, I.; REY, R.; FINKIELSTAIN, G.

Milan

Congreso; 9th Joint Meeting of Paediatrics Endocrinology; 2013

ENDO, SLEP

Background: Growth hormone stimulation testing (GHST) has been used as standard investigation in patients with clinical criteria suggestive of GHD. However, these tests are invasive and may raise safety issues, especially in a child with co-morbidities. Different studies aimed to identify risk factors for GHD but most focused on the differential diagnosis between idiopathic short stature and GHD in apparently healthy children. Objective and hypotheses: To assess the association between GHD and the history of surgery or radiation of the sellar or suprasellar region or another anterior pituitary deficiency associated with specific clinical and imaging features, by evaluating the response to GHST. Methods: Case-control study with retrospective clinical chart review of all patients meeting the criteria for GHST. GHD was diagnosed with GH peaks below 6 ng/ml (ECLIA) during sequential Arginine-Clonidine tests. Results: 205 patients were analysed. 14/50 GHD patients had the postulated risk factors, while these were found in only 1/155 patients without GHD. 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 probability of having a risk factor was almost 60-fold higher (OR: 59.9, 95% CI 7.6-470.6) in the GHD group, and the risk of having GHD was approximately 5-fold higher (RR: 4.93, 95% CI: 3.56-6.81) in patients with one of the postulated risk factors. Conclusions: Our findings clearly identified surgery of the sellar or suprasellar region, cranial radiotherapy and coexistence of congenital multiple pituitary hormone deficiencies with hypogenitalism in males, neonatal hypoglycaemia or cholestasis, diabetes insipidus or midline defects as major risk factors for GHD in paediatric patients meeting the criteria for GHST.