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

Puerto Varas

Congreso; XXV Annual Meeting of the Latin American Pediatric Endocrinology Society (SLEP; 2015

Sociedad Latinoamericana de Endocrinología Pediátrica

Background: Growth hormone provocation tests (GHPT)have been used as a standard diagnostic tool in patients with clinicaland biochemical criteria suggestive of GHD. However, thesetests are invasive, need a standardized protocol, should be carefully monitored by an experienced team and may raise safety issues,especially in a child with co-morbidities. Previous studiesaiming to identify risk factors for GHD do not include specificknown phenotypes and/or clinical findings that could anticipateGHD.Objective: To identify risk factors that might predict with highaccuracy the presence GHD in children eligible for GHPT.Patients and Methods: Case-control retrospective study, withclinical chart review of all patients meeting the criteria for GHPTbetween 2005 and 2014.Results: Seventy-three out of 364 patients who underwentGHPT had GHD. The presence of history of sellar and/or suprasellarregion surgery, one or more anterior pituitary deficiency associatedwith diabetes insipidus, hypogenitalism in males, neonatalhypoglycaemia or cholestasis, craniofacial midline defects or pituitarydysgenesis by imaging studies showed a positive predictivevalue of 100% (IC 95% 0.83 to 1.00) to diagnose GHD. Using thisproposed group of risk factors in our study population, 21 patientscould have been identified as GHD without GHPT (28.8% of GHDpatients). There was a strong association between GHD and theexistence of at least one of the postulated risk factors (Fisher?s exacttest 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 predictedGHD with high accuracy. Therefore, in patients with theserisk factors, performing GHPT would not be necessary to confirmthe diagnosis of GHD.P55Growth Rate Ranges