{"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":1788808088782,"version":"build-2803163510"},"reference-count":39,"publisher":"S. Karger AG","issue":"5","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"},{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuroendocrinology"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>&lt;b&gt;&lt;i&gt;Introduction:&lt;\/i&gt;&lt;\/b&gt; The diagnosis of growth hormone deficiency (GHD) in adults is based on a reduced GH response to provocative tests, such as the insulin tolerance test (ITT) and the GH-releasing hormone (GHRH) + arginine (ARG) test. However, the cut-off limits of peak GH response in lean subjects are not reliable in obese patients; this is noteworthy since adult GHD is often associated with obesity. To date, there are no ITT cut-offs related to body mass index (BMI). &lt;b&gt;&lt;i&gt;Objective:&lt;\/i&gt;&lt;\/b&gt; We aimed to evaluate the diagnostic cut-offs of GH response to the ITT in the function of BMI. &lt;b&gt;&lt;i&gt;Methods:&lt;\/i&gt;&lt;\/b&gt; The GH response to the ITT was studied in 106 patients with a history of hypothalamic-pituitary disease, a mean age of 48.2 \u00b1 12.4 years, and a mean BMI of 26.8 \u00b1 6.1 kg\/m&lt;sup&gt;2&lt;\/sup&gt;). Patients were divided into lean, overweight, and obese groups according to their BMI. The lack of GH response to GHRH + ARG test was considered the gold standard for the diagnosis of GHD. The best GH cut-off in the ITT, defined as the one with the best sensitivity (SE) and specificity (SP), was identified using receiver-operating characteristics curve (ROC) analysis. &lt;b&gt;&lt;i&gt;Results:&lt;\/i&gt;&lt;\/b&gt; The best GH cut-off in the ITT was 3.5 \u03bcg\/L in lean subjects (SE 82.1%; SP 85.7%), 1.3 \u03bcg\/L in overweight subjects (SE 74.1%; SP 85.7%), and 2.2 \u03bcg\/L in obese subjects (SE 90.0%; SP 50.0%). The diagnostic accuracy was 97.2, 76.5, and 76.7%, respectively. &lt;b&gt;&lt;i&gt;Conclusions:&lt;\/i&gt;&lt;\/b&gt; Our data show that the ITT represents a reliable diagnostic tool for the diagnosis of adult GHD in lean subjects if an appropriate cut-off limit is assumed. Overweight and obesity strongly reduce the GH response to the ITT, GH BMI-related cut-off limits, and the diagnostic reliability of the test. <\/jats:p>","DOI":"10.1159\/000508103","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T21:00:33Z","timestamp":1587762033000},"page":"442-450","source":"Crossref","is-referenced-by-count":17,"title":["The Cut-off Limits of Growth Hormone Response to the Insulin Tolerance Test Related to Body Mass Index for the Diagnosis of Adult Growth Hormone Deficiency"],"prefix":"10.1159","volume":"111","author":[{"given":"Valentina","family":"Gasco","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Ferrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bisceglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nunzia","family":"Prencipe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Cambria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Bioletto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezio","family":"Ghigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Maccario","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Grottoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2011-0179"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4059"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1054\/ghir.2001.0263"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-031601"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ghir.2011.01.001"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1239"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp020186"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.4158\/EP.15.S2.1"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-07-0631"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-09-0291"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-73-5-1081"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-012006"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-72-1-51"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511549304.003"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.4158\/EP14603.OR"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02525.x"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2830"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1530\/eje.1.01967"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1007\/BF03346389"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/39.4.561"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1420347"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-71-6-1481"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021094"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/0026-0495(92)90220-5"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.1995.tb00532.x"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0800356"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1007\/BF03343585"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-032213"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1450"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2005.02272.x"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-0304"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.6.8546"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.ghir.2009.09.005"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2010.150631"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90181-3"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.5.8509"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-140-3-200402030-00010"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02755-0"},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.85.4.6545"}],"container-title":["Neuroendocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/508103","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.karger.com\/Article\/Pdf\/508103","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T16:07:04Z","timestamp":1745424424000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000508103"}},"subtitle":[],"shor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