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The utility of the GHRH-arginine test for diagnosing GH deficiency in adults with childhood acute lymphoblastic leukemia (ALL) treated with cranial irradiation.

Björk, Jonas LU ; Link, Katarina LU and Erfurth, Eva Marie LU (2005) In Journal of Clinical Endocrinology and Metabolism 90(11). p.6048-6054
Abstract
Context: The insulin tolerance test ( ITT) is the current standard diagnostic test for the diagnosis of adult GH deficiency ( GHD), but alternative tests, such as the GHRH- arginine test, have been proposed. Objective: We investigated the sensitivity and specificity of the GHRH- arginine test using ITT as the gold standard in diagnosing GHD in a group of young adults treated with cranial irradiation ( CRT) for childhood acute lymphoblastic leukemia ( ALL). We estimated the positive and negative predictive values of the GHRH- arginine test among patients as well as a number of individual characteristics and therapy- related factors during both the GHRH- arginine test and ITT. Design: Forty- three young adults, treated for childhood ALL with... (More)
Context: The insulin tolerance test ( ITT) is the current standard diagnostic test for the diagnosis of adult GH deficiency ( GHD), but alternative tests, such as the GHRH- arginine test, have been proposed. Objective: We investigated the sensitivity and specificity of the GHRH- arginine test using ITT as the gold standard in diagnosing GHD in a group of young adults treated with cranial irradiation ( CRT) for childhood acute lymphoblastic leukemia ( ALL). We estimated the positive and negative predictive values of the GHRH- arginine test among patients as well as a number of individual characteristics and therapy- related factors during both the GHRH- arginine test and ITT. Design: Forty- three young adults, treated for childhood ALL with 18 - 30 Gy CRT and chemotherapy, were studied, and comparison was made with matched controls. Results and Conclusions: We evaluated four different cutoff levels for GHD in the GHRH- arginine test: 5, 7.5, 9, and 16.5 mu g/ liter. Using 7.5 mu g/liter as the cutoff yielded high specificity ( 94%), but at the same time the sensitivity was only 66%, which leads to a low negative predictive value ( 27%). In contrast, a failed GH response to the GHRH- arginine test accurately reflects the presence of radiationinduced GHD, illustrated by a high positive predictive value ( 95% at 7.5 mu g/ liter). Only age at CRT and body mass index remained significant predictors of the peak GH during the GHRH- arginine test. Because a high proportion of GHD patients show a normal response to the GHRH- arginine test, it cannot be used reliably to exclude GHD in these patients. Complementary ITT is also warranted to confirm GHD in obese patients. (Less)
Please use this url to cite or link to this publication:
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type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Endocrinology and Metabolism
volume
90
issue
11
pages
6048 - 6054
publisher
Oxford University Press
external identifiers
  • pmid:16131575
  • wos:000233115700019
  • scopus:27744594154
ISSN
1945-7197
DOI
10.1210/jc.2005-0304
language
English
LU publication?
yes
id
975a3483-6acb-403b-a456-56e985ba2675 (old id 143978)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16131575&dopt=Abstract
date added to LUP
2016-04-01 16:21:13
date last changed
2024-01-11 06:21:25
@article{975a3483-6acb-403b-a456-56e985ba2675,
  abstract     = {{Context: The insulin tolerance test ( ITT) is the current standard diagnostic test for the diagnosis of adult GH deficiency ( GHD), but alternative tests, such as the GHRH- arginine test, have been proposed. Objective: We investigated the sensitivity and specificity of the GHRH- arginine test using ITT as the gold standard in diagnosing GHD in a group of young adults treated with cranial irradiation ( CRT) for childhood acute lymphoblastic leukemia ( ALL). We estimated the positive and negative predictive values of the GHRH- arginine test among patients as well as a number of individual characteristics and therapy- related factors during both the GHRH- arginine test and ITT. Design: Forty- three young adults, treated for childhood ALL with 18 - 30 Gy CRT and chemotherapy, were studied, and comparison was made with matched controls. Results and Conclusions: We evaluated four different cutoff levels for GHD in the GHRH- arginine test: 5, 7.5, 9, and 16.5 mu g/ liter. Using 7.5 mu g/liter as the cutoff yielded high specificity ( 94%), but at the same time the sensitivity was only 66%, which leads to a low negative predictive value ( 27%). In contrast, a failed GH response to the GHRH- arginine test accurately reflects the presence of radiationinduced GHD, illustrated by a high positive predictive value ( 95% at 7.5 mu g/ liter). Only age at CRT and body mass index remained significant predictors of the peak GH during the GHRH- arginine test. Because a high proportion of GHD patients show a normal response to the GHRH- arginine test, it cannot be used reliably to exclude GHD in these patients. Complementary ITT is also warranted to confirm GHD in obese patients.}},
  author       = {{Björk, Jonas and Link, Katarina and Erfurth, Eva Marie}},
  issn         = {{1945-7197}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{6048--6054}},
  publisher    = {{Oxford University Press}},
  series       = {{Journal of Clinical Endocrinology and Metabolism}},
  title        = {{The utility of the GHRH-arginine test for diagnosing GH deficiency in adults with childhood acute lymphoblastic leukemia (ALL) treated with cranial irradiation.}},
  url          = {{http://dx.doi.org/10.1210/jc.2005-0304}},
  doi          = {{10.1210/jc.2005-0304}},
  volume       = {{90}},
  year         = {{2005}},
}