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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)
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organization
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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
The Endocrine Society
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
2007-06-27 12:41:51
date last changed
2017-09-24 04:26:07
@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    = {The Endocrine Society},
  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},
  volume       = {90},
  year         = {2005},
}