{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T05:37:50Z","timestamp":1698212270548},"reference-count":28,"publisher":"The Endocrine Society","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,5,1]]},"abstract":"<jats:p>There is now wide consensus that, within an appropriate clinical context, GH deficiency (GHD) in adults must be shown biochemically by provocative testing of GH secretion and that appropriate cut-off limits have to be defined for each provocative test. Insulin-induced hypoglycemia (ITT) is indicated as the test of choice, and severe GHD, to be treated with recombinant human GH replacement, is defined by a GH peak response to ITT of less than 3 \u03bcg\/L. GHRH + arginine (GHRH+ARG) is one of the most promising tests in alternative to ITT. In fact, it has been reported as a potent, reproducible, and age-independent test and that it is able to distinguish between GHD and normal adults. The aim of the present study was to compare the GH response to ITT and GHRH+ARG in a large group of hypopituitary adults (n = 40; 29 male and 11 female; age: 36.4 \u00b1 2.1 yr). The third centile limit of the peak GH response to ITT has been reported as 5 \u03bcg\/L, whereas in our lab, that to GHRH+ARG is 16.5 \u03bcg\/L. In hypopituitary adults, the mean peak GH response to ITT (1.5 \u00b1 0.2 \u03bcg\/L, range: 0.1\u20138.5\u03bc g\/L) was lower (P &amp;lt; 0.001) than that to GHRH+ARG (3.0 \u00b1 0.4 \u03bcg\/L, range 0.1\u201312.0 \u03bcg\/L), though there was positive correlation (r = 0.61, P &amp;lt; 0.001) between the GH responses to the 2 tests. The peak GH response to GHRH+ARG, but not that to ITT, was positively (though weakly) associated with insulin-like growth factor-I levels (r = 0.35, P &amp;lt; 0.03). Childhood and adult onset GHD patients, as well as patients with single and multiple pituitary insufficiencies, had similar peak GH responses to ITT or GHRH+ARG. Analyzing individual GH responses, 4\/40 (10%) of the hypopituitary patients had GH peaks higher than 5 \u03bcg\/L after ITT; moreover, 3 other patients (7%) had GH peaks, after ITT, higher than 3 \u03bcg\/L. On the other hand, after GHRH+ARG, all patients had GH peaks lower than 16.5 \u03bcg\/L, whereas 21\/40 (52.5%) had GH peaks higher than 3 \u03bcg\/L. Because 3 \u03bcg\/L is the arbitrary cut-off for ITT, the third centile limit of which is 5\u03bc g\/L, we arbitrarily considered 9 \u03bcg\/L as the cut-off point for GHRH+ARG. It is noteworthy that 37\/40 (92.5%) patients had a GH peak,. after GHRH+ARG, below this limit. In conclusion, our present results confirm that the ITT test is a reliable provocative test for the diagnosis of adult GHD, whereas they show that the GHRH+ARG test is, at least, as sensitive as the ITT test (provided that appropriate cut-off limits are considered). Note that even the arbitrary cut-off point below which severe GHD is demonstrated has to be appropriate to the potency of the test.<\/jats:p>","DOI":"10.1210\/jcem.83.5.4837","type":"journal-article","created":{"date-parts":[[2014,1,8]],"date-time":"2014-01-08T17:02:55Z","timestamp":1389200575000},"page":"1615-1618","source":"Crossref","is-referenced-by-count":6,"title":["Comparison between Insulin-Induced Hypoglycemia and Growth Hormone (GH)-Releasing Hormone + Arginine as Provocative Tests for the Diagnosis of GH Deficiency in Adults1"],"prefix":"10.1210","volume":"83","author":[{"given":"G.","family":"Aimaretti","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Corneli","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Razzore","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Bellone","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Baffoni","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Arvat","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Camanni","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Ghigo","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine, University of Turin, 10126 Turin Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","reference":[{"key":"2020071618505835900_R1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1210\/er.16.1.63","article-title":"Clinical aspects of growth hormone deficiency in adults.","volume":"16","author":"De Boer","year":"1995","journal-title":"Endocr Rev"},{"key":"2020071618505835900_R2","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/S0140-6736(89)92328-3","article-title":"Beneficial effects of growth hormone treatment in GH-deficient adults","volume":"i","author":"Jorgensen","year":"1989","journal-title":"Lancet."},{"key":"2020071618505835900_R3","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1056\/NEJM198912283212605","article-title":"The effects of treatment with recombinant human growth hormone on body composition and metabolism in adults with growth hormone deficiency.","volume":"321","author":"Salomon","year":"1989","journal-title":"N Engl J Med"},{"key":"2020071618505835900_R4","first-page":"695","article-title":"Growth hormone treatment in growth hormone deficient adults. 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