Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2007) 14 P542

ECE2007 Poster Presentations (1) (659 abstracts)

Analysis of three different tests in the diagnosis of growth hormone deficit (GHD) in patients with severe cerebral trauma

A Soto 1 , E Venegas 1 , A Caro 1 , R Gurrero 1 , MD Rincon 2 , S Garcia 2 , A Pumar 1 , A Leon 3 , JM Flores 2 , F Murillo 2 & A Leal-Cerro 1


1Department of Endocrinology, HH.UU Virgen del Rocío, Sevilla, Spain; 2Department of Critical Care, HH.UU Virgen del Rocío, Sevilla, Spain; 3Department of Laboratory, HH.UU Virgen del Rocío, Sevilla, Spain.


Introduction: Patients with severe cerebral Trauma are a risk population for developing hipopituytarism. Diagnosis of GHD need to study pituitary gland reserve with a stimulation test. Insulin Tolerance test (ITT) is the best standard test, although has important contraindication in these patients and its realization is not always a possible. We evaluate the diagnostic capacity of two alternative test (Glucagon Test an GHRH-GHRP6 test) and compared them with ITT.

Material and methods: In 52 adult patients with severe cerebral trauma (Glasgow < 8) occurred at least 12 month before study, we perform three consecutive test, with a minimum period of 72 hours among each other, in the following order: (1) Glucagon test. Glucagon 1 mg s.c with extractions at 90, 120, 150, 180, 210 and 240 minutes to determinate GH and glucose. (2) GHRH-GHRP-6 test. GHRH 100 mg and GHRP-6 100 mg, bolus i.v, and extractions in 0, 30, 60, 90 and 120 minutes to determinate GH. (3) ITT. Regular insulin 0.05–0.15 UI/Kg, bolus i.v and extractions in 0, 30, 60 minutes to determinate GH and Glucose, to get glucose level <40 mg/dl. In 10 patients ITT could not be done because of contraindications. GH values used for diagnosis of GHD are those published in de literature for each of these test. (Glucagon test, <3 mg/dl, GHRH-GHRP-6 <15 mg/dl and ITT < 3 mg/ml).

Results: 15/47 (31.91%) patients were diagnosticated of GHD with ITT, 8/58 (13.57%) patients were diagnosticated of GHD with GHRH-GHRP-6 test and 23/46 (41.07%) patients were diagnosticated of GHD with Glucagon test. Glucagon test sensitivity and specificity was 73.3%, Positive Predictive Value was 57.8% and Negative Predictive Value 84.61%, when we compared with ITT. GHRH-GHRP-6 test sensitivity was 40% and specificity was 100%, Positive Predictive Value was 100% and Negative Predictive Value 82.92%, when we compared with ITT.

Conclusions: Variability among three test is important. Glucagon test is not a good test since it has neither good sensitivity nor specificity. GHRP-GHRP-6 test is very specific, and may be valuable as confirmation test.

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