{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:25:12Z","timestamp":1791228312326,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,12,22]],"date-time":"2022-12-22T00:00:00Z","timestamp":1671667200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/N022556\/1"],"award-info":[{"award-number":["MR\/N022556\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["MR\/S017151\/1"],"award-info":[{"award-number":["MR\/S017151\/1"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Growth hormone stimulation testing (GHST) is used to diagnose growth hormone deficiency (GHD) in children. As sex steroids impact on anterior pituitary function, there is concern around the efficacy of GHST in peripubertal children, where endogenous sex steroid levels are low. Sex steroid priming before GHST is thought to improve test efficacy in these children, however evidence to support its use in clinical practice is limited.<\/jats:p><\/jats:sec><jats:sec><jats:label\/><jats:p>In this systematic review, we addressed the following research questions: Does priming increase GH stimulation test efficacy in peripubertal children? Does priming identify those who would benefit most from treatment in terms of final height? Is there evidence for an optimal sex\u2010steroid priming regimen?<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Patients, Measurements<\/jats:title><jats:p>The study was registered with PROSPERO and conducted according to PRISMA guidelines. We searched Medline, Cochrane\u2010Library, Scopus, EMBASE and Web\u2010of\u2010Science and included all studies that included GHST in both primed and unprimed children. A GH cut\u2010off of 7\u2009\u00b5g\/L was used as a threshold for GHD. Study quality was assessed using the Risk\u2010Of\u2010Bias in Non\u2010 Randomized Studies (ROBINS\u2010I) tool or the revised Cochrane risk\u2010of\u2010bias tool for Randomised trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifteen studies met our inclusion criteria, of which 4\/15 (27%) were randomised control trials. The majority (9\/15) of the studies indicated that priming increases growth hormone response upon GHST in peripubertal children, increasing test specificity. Two studies investigated final height after treatment based on the results of primed versus unprimed GHST. These results indicate that growth hormone treatment based on results of a primed GHST improve outcomes compared with treatment based on an unprimed test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sex\u2010steroid priming increases the growth hormone response during GHST, resulting in fewer patients meeting the threshold required for a diagnosis of GHD. Unnecessary GH treatment may be avoided in some patients without a detrimental effect on final height. Numerous sex\u2010steroid priming regimens have been used in clinical practice and the majority appear to be effective, but an optimal regimen has not been determined.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14862","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T09:40:50Z","timestamp":1671010850000},"page":"527-535","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Sex steroid priming for growth hormone stimulation testing in children and adolescents with short stature: A\u00a0systematic review"],"prefix":"10.1111","volume":"98","author":[{"given":"Gregor","family":"Duncan","sequence":"first","affiliation":[{"name":"Royal Hospital for Children and Young People Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1596-860X","authenticated-orcid":false,"given":"Sarah","family":"Kiff","sequence":"additional","affiliation":[{"name":"Royal Hospital for Children and Young People Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-3765","authenticated-orcid":false,"given":"Rod T.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Royal Hospital for Children and Young People Edinburgh UK"},{"name":"MRC Centre for Reproductive Health, Queen's Medical Research Institute The University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2014-307228"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.10.6858"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.82.2.3726"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"7","article-title":"Growth hormone (GH) secretion in patients with childhood\u2010onset GH deficiency: retesting after one year of therapy and at final height","volume":"59","author":"Thomas M","year":"2003","journal-title":"Horm Res"},{"issue":"6","key":"e_1_2_9_6_1","first-page":"1521","article-title":"Hormonal determinants of pubertal growth","volume":"14","author":"Delemarre\u2010van de Waal HA","year":"2001","journal-title":"J Pediatr Endocrinol Metab"},{"issue":"6","key":"e_1_2_9_7_1","first-page":"1407","article-title":"Activation of the somatotropic axis by testosterone in adult males: evidence for the role of aromatization","volume":"76","author":"Weissberger AJ","year":"1993","journal-title":"J\u00a0Clin\u00a0Endocr\u00a0Metab"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0015-0282(97)81483-5"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02676.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.81.9.3323"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.122729"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.79.2.537"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.11.6928"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1986.02140160042027"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000284396"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000323353"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1159\/000452150"},{"issue":"11","key":"e_1_2_9_18_1","first-page":"3990","article-title":"Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. 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