{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:08:08Z","timestamp":1788808088043,"version":"build-2803163510"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006692","name":"Universit\u00e0 degli Studi di Torino","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006692","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pituitary"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>In adults with hypothalamic\u2013pituitary disease, the presence of at least three additional pituitary hormone deficiencies, with or without markedly reduced IGF-I levels, is considered diagnostic of growth hormone deficiency (GHD) without the need for stimulation testing. In all other cases, dynamic testing is required despite its well-recognized limitations. To date, no formal strategy has been proposed to exclude GHD without performing stimulation tests.<\/jats:p>\n                    <jats:p>This study aims to develop a probabilistic model to estimate the likelihood of GHD in adults with hypothalamic\u2013pituitary disease but no additional pituitary hormone deficiencies, based on IGF-I standard deviation scores (SDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We combined literature-derived data on: (1) the probability of an impaired GH response to stimulation tests in patients with hypothalamic\u2013pituitary disease and preserved anterior pituitary function; and (2) the probability that adults with isolated GHD present IGF-I SDS values\u2009\u2265\u20090, \u2265 0.5, or \u2265\u20091. A Bayesian approach was applied to estimate the post-test probability of GHD in patients meeting these criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>Across all models, the estimated probability of adult-onset GHD ranged from 6.5% to 19.8%, while the probability of childhood-onset GHD ranged from 2.9% to 9.1%, consistently remaining below 20%, regardless of the IGF-I SDS cut-off applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In adults with hypothalamic\u2013pituitary disease but no additional hormonal deficiencies, IGF-I SDS values\u2009\u2265\u20090 identify a subgroup with a low, clinically acceptable probability of GHD, in whom stimulation testing may reasonably be avoided. This proof-of-concept model supports a simplified, probability-based diagnostic approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11102-026-01697-3","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T17:02:32Z","timestamp":1784826152000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["GH Stimulation testing is unnecessary in patients with hypothalamic\u2013pituitary disease, preserved pituitary function, and IGF-I SDS\u2009\u2265\u20090"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6491-5731","authenticated-orcid":false,"given":"Valentina","family":"Gasco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Cuboni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Sibilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Mocellini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Martinotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Lucisano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Ghigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Aimaretti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Grottoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Maccario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"1697_CR1","unstructured":"Monson JP, Brooke AM, Akker S (2015) Adult growth hormone deficiency. 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No individual participant data were collected or accessed. Therefore, institutional review board approval and informed consent were not required.","order":1,"name":"Ethics","label":"Ethics statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no non-financial interests to disclose.","order":2,"name":"Ethics","label":"Non-financial interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"129"}}