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Pituitary Function Assessment in Short Stature by a Combined Hormonal-Stimulation Test

Pituitary Function Assessment in Short Stature by a Combined Hormonal-Stimulation Test Abstract • We utilized combined, hormonal-stimulation test (CHST) using sequentially-administered insulin, thyrotropin-releasing hormone, gonadotropin-releasing hormone, and levodopa to assess 51 children with short stature and/or pathologic growth. Growth hormone, thyrotropin, gonadotropins, cortisol, and prolactin levels were sampled over two hours. All patients with appropriate predicted adult heights, delayed bone ages, and normal growth velocities of 4.0 cm/y or greater demonstrated normal pituitary responses. Two of 12 patients with predicted heights 2.5 SDs lower than target height and normal growth velocity demonstrated isolated growth hormone deficiency. Nine of 11 patients had a pathologic growth hormone deficiency or panhypopituitarism. Evaluation of pituitary function by combined sequential hormonal stimulation is fruitful in children with pathologic growth patterns but not in children with normal growth velocities and normal predicted adult height. (AJDC 1987;141:556-561) References 1. Lifshitz F, Zandsberg S: Disorders of growth , in Lifshitz F (ed): Pediatric Endocrinology: A Clinical Guide . New York, Marcel Dekker Inc, 1985, pp 3-36. 2. Underwood LE, VanWyke JJ: Normal and aberrant growth , in Wilson JD, Foster DW (eds): Williams Textbook of Endocrinology , ed 7. Philadelphia, WB Saunders Co, 1985, pp 155-205. 3. Johanson AJ, Morris GL: A single growth hormone determination to rule out hormone deficiency . Pediatrics 1977;59:467-468. 4. Lanes R, Recker B, Fort P, et al: Low-dose oral clonidine: A simple and reliable growth hormone test for children . AJDC 1985;139:87-88. 5. Frederikson PK, Pallisgard G, Jacobson JG: Stimulation tests for growth hormone . Danish Med Bull 1979;26:304-308. 6. Johanson AJ: Growth hormone disorders and treatment , in Lifshitz F (ed): Pediatric Endocrinology: A Clinical Guide . New York, Marcel Dekker Inc, 1985, pp 61-85. 7. Ad hoc Committee on Growth Hormone Usage, The Lawson Wilkins Pediatric Endocrine Society, and Committee on Drugs: Growth hormone in the treatment of children with short stature . Pediatrics 1983;76:891-894. 8. Tanner JM, Goldstein H, Whitehouse RH: Standards for children's height at ages 2-9 years, allowing for height of parents . Arch Dis Child 1970;45:755-762.Crossref 9. Tanner JM, Whitehouse RH, Marshall WA, et al: Prediction of adult height from height, bone age, and occurrence of menarche at ages 4-16 with allowance for midparent height . Arch Dis Child 1975;50:14-26.Crossref 10. Bayley N, Pinneau SR: Tables for predicting adult height from skeletal age: Revised for use with the Greulich-Pyle hand standards . J Pediatr 1952;40:423-441.Crossref 11. Roche AF, Wainer H, Thissen D: The RWT method for the prediction of adult stature . Pediatrics 1975;56:1026-1033. 12. Greulich WW, Pyle SI: Radiographic Atlas of Skeletal Development of the Hand and Wrist , ed 2. Stanford, Calif, Stanford University Press, 1959. 13. Tanner JM: Growth at Adolescence , ed 2. Oxford, England, Blackwell Scientific Publications, 1962. 14. Hamill PVV, Drizd TA, Johnson CL, et al: Physical growth: National Center for Health Statistics percentiles . Am J Clin Nutr 1979;32: 607-629. 15. Lamberton RP, Jackson IMD: Investigation of hypothalamic pituitary disease . Clin Endocrinol Metab 1983;12:509-534.Crossref 16. Spiliotis BE, August GP, Hung WH: Growth hormone neurosecretory dysfunction: A treatable cause of short stature . JAMA 1984;251: 2230-2233.Crossref 17. Rudman D, Kutner MH, Blackston RD, et al: Children with normal-variant short stature: Treatment with human growth hormone for six months . N Engl J Med 1981;305:123-131.Crossref 18. Bright GM, Rogol AD, Johanson AJ, et al: Short stature associated with normal growth hormone and decreased somatomedin-C concentration: Response to exogenous growth hormone . Pediatrics 1983;71:576-580. 19. Garvier PE, Raymond F, Job JC: Companion of growth hormone sleep release and responses to pharmacological tests . Hormone Res 1985;22:12-16.Crossref 20. Zadik Z, Chalew SA, Raiti S, et al: Do short children secrete insufficient growth hormone? Pediatrics 1985;76:355-360. 21. Rosenfeld RG, Wilson DM, Lee PDK, et al: Insulin-like growth factors I and II in evaluation of growth retardation . J Pediatr 1986;109: 428-433.Crossref 22. Phillips LS, Unterman TG: Somatomedin activity in disorders of nutrition and metabolism . Clin Endocrinol Metab 1984;13:145-189.Crossref 23. Mortimer CH, Besser GM, McNeilly AS, et al: Interaction between secretion of the gonadotropins, prolactin, growth hormone, thyrotropin and corticosteroids in man: The effects of LH/FSH-RH, TRH and hypoglycemia alone and in combination . Clin Endocrinol 1973;2: 317-324.Crossref 24. Esposito V, Bellastella A, D'Allesandro B, et al: LH, FSH, TSH, Prolattina e cortisolo plasmatici in corso di test combinato di riserva ipofisaria in soggetti prepuberi con bassa statura . Boll Soc Ital Biol Sper 1978;54:2561-2564. 25. Griffin JE: Dynamic tests of endocrine function , in Wilson JD, Foster DW (eds): Williams Textbook of Endocrinology , ed 7. Philadelphia, WB Saunders Co, 1985, pp 147-154. 26. Lanes R, Herrera A, Palacious A, et al: Decreased secretion of cortisol and ACTH after oral clonidine administration in normal adults . Metabolism 1983;32:568-570.Crossref 27. Nickerson M, Collier B: Drugs inhibiting adrenergic nerves and structures innervated by them , in Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1975, pp 533-564. 28. Barbarino A, DeMartinis L, Martino F: Effect of hyperglycemia on the growth hormone response to L-dopa in diabetic subjects . J Endocrinol Invest 1978;1:259-263.Crossref 29. Sheldon WR, DeBold CR, Evans WS, et al: Rapid sequential intravenous administration of four hypothalamic releasing hormones as a combined anterior pituitary function test in normal subjects . J Clin Endocrinol Metab 1985;60: 623-630.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

Pituitary Function Assessment in Short Stature by a Combined Hormonal-Stimulation Test

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1987.04460050098040
Publisher site
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Abstract

Abstract • We utilized combined, hormonal-stimulation test (CHST) using sequentially-administered insulin, thyrotropin-releasing hormone, gonadotropin-releasing hormone, and levodopa to assess 51 children with short stature and/or pathologic growth. Growth hormone, thyrotropin, gonadotropins, cortisol, and prolactin levels were sampled over two hours. All patients with appropriate predicted adult heights, delayed bone ages, and normal growth velocities of 4.0 cm/y or greater demonstrated normal pituitary responses. Two of 12 patients with predicted heights 2.5 SDs lower than target height and normal growth velocity demonstrated isolated growth hormone deficiency. Nine of 11 patients had a pathologic growth hormone deficiency or panhypopituitarism. Evaluation of pituitary function by combined sequential hormonal stimulation is fruitful in children with pathologic growth patterns but not in children with normal growth velocities and normal predicted adult height. (AJDC 1987;141:556-561) References 1. Lifshitz F, Zandsberg S: Disorders of growth , in Lifshitz F (ed): Pediatric Endocrinology: A Clinical Guide . New York, Marcel Dekker Inc, 1985, pp 3-36. 2. Underwood LE, VanWyke JJ: Normal and aberrant growth , in Wilson JD, Foster DW (eds): Williams Textbook of Endocrinology , ed 7. Philadelphia, WB Saunders Co, 1985, pp 155-205. 3. Johanson AJ, Morris GL: A single growth hormone determination to rule out hormone deficiency . Pediatrics 1977;59:467-468. 4. Lanes R, Recker B, Fort P, et al: Low-dose oral clonidine: A simple and reliable growth hormone test for children . AJDC 1985;139:87-88. 5. Frederikson PK, Pallisgard G, Jacobson JG: Stimulation tests for growth hormone . Danish Med Bull 1979;26:304-308. 6. Johanson AJ: Growth hormone disorders and treatment , in Lifshitz F (ed): Pediatric Endocrinology: A Clinical Guide . New York, Marcel Dekker Inc, 1985, pp 61-85. 7. Ad hoc Committee on Growth Hormone Usage, The Lawson Wilkins Pediatric Endocrine Society, and Committee on Drugs: Growth hormone in the treatment of children with short stature . Pediatrics 1983;76:891-894. 8. Tanner JM, Goldstein H, Whitehouse RH: Standards for children's height at ages 2-9 years, allowing for height of parents . Arch Dis Child 1970;45:755-762.Crossref 9. Tanner JM, Whitehouse RH, Marshall WA, et al: Prediction of adult height from height, bone age, and occurrence of menarche at ages 4-16 with allowance for midparent height . Arch Dis Child 1975;50:14-26.Crossref 10. Bayley N, Pinneau SR: Tables for predicting adult height from skeletal age: Revised for use with the Greulich-Pyle hand standards . J Pediatr 1952;40:423-441.Crossref 11. Roche AF, Wainer H, Thissen D: The RWT method for the prediction of adult stature . Pediatrics 1975;56:1026-1033. 12. Greulich WW, Pyle SI: Radiographic Atlas of Skeletal Development of the Hand and Wrist , ed 2. Stanford, Calif, Stanford University Press, 1959. 13. Tanner JM: Growth at Adolescence , ed 2. Oxford, England, Blackwell Scientific Publications, 1962. 14. Hamill PVV, Drizd TA, Johnson CL, et al: Physical growth: National Center for Health Statistics percentiles . Am J Clin Nutr 1979;32: 607-629. 15. Lamberton RP, Jackson IMD: Investigation of hypothalamic pituitary disease . Clin Endocrinol Metab 1983;12:509-534.Crossref 16. Spiliotis BE, August GP, Hung WH: Growth hormone neurosecretory dysfunction: A treatable cause of short stature . JAMA 1984;251: 2230-2233.Crossref 17. Rudman D, Kutner MH, Blackston RD, et al: Children with normal-variant short stature: Treatment with human growth hormone for six months . N Engl J Med 1981;305:123-131.Crossref 18. Bright GM, Rogol AD, Johanson AJ, et al: Short stature associated with normal growth hormone and decreased somatomedin-C concentration: Response to exogenous growth hormone . Pediatrics 1983;71:576-580. 19. Garvier PE, Raymond F, Job JC: Companion of growth hormone sleep release and responses to pharmacological tests . Hormone Res 1985;22:12-16.Crossref 20. Zadik Z, Chalew SA, Raiti S, et al: Do short children secrete insufficient growth hormone? Pediatrics 1985;76:355-360. 21. Rosenfeld RG, Wilson DM, Lee PDK, et al: Insulin-like growth factors I and II in evaluation of growth retardation . J Pediatr 1986;109: 428-433.Crossref 22. Phillips LS, Unterman TG: Somatomedin activity in disorders of nutrition and metabolism . Clin Endocrinol Metab 1984;13:145-189.Crossref 23. Mortimer CH, Besser GM, McNeilly AS, et al: Interaction between secretion of the gonadotropins, prolactin, growth hormone, thyrotropin and corticosteroids in man: The effects of LH/FSH-RH, TRH and hypoglycemia alone and in combination . Clin Endocrinol 1973;2: 317-324.Crossref 24. Esposito V, Bellastella A, D'Allesandro B, et al: LH, FSH, TSH, Prolattina e cortisolo plasmatici in corso di test combinato di riserva ipofisaria in soggetti prepuberi con bassa statura . Boll Soc Ital Biol Sper 1978;54:2561-2564. 25. Griffin JE: Dynamic tests of endocrine function , in Wilson JD, Foster DW (eds): Williams Textbook of Endocrinology , ed 7. Philadelphia, WB Saunders Co, 1985, pp 147-154. 26. Lanes R, Herrera A, Palacious A, et al: Decreased secretion of cortisol and ACTH after oral clonidine administration in normal adults . Metabolism 1983;32:568-570.Crossref 27. Nickerson M, Collier B: Drugs inhibiting adrenergic nerves and structures innervated by them , in Goodman LS, Gilman A (eds): The Pharmacological Basis of Therapeutics , ed 5. New York, Macmillan Publishing Co Inc, 1975, pp 533-564. 28. Barbarino A, DeMartinis L, Martino F: Effect of hyperglycemia on the growth hormone response to L-dopa in diabetic subjects . J Endocrinol Invest 1978;1:259-263.Crossref 29. Sheldon WR, DeBold CR, Evans WS, et al: Rapid sequential intravenous administration of four hypothalamic releasing hormones as a combined anterior pituitary function test in normal subjects . J Clin Endocrinol Metab 1985;60: 623-630.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: May 1, 1987

References