ECE2007 Poster Presentations (1) (659 abstracts)
Analysis of three different tests in the diagnosis of growth hormone deficit (GHD) in patients with severe cerebral trauma
A Soto 1 , E Venegas 1 , A Caro 1 , R Gurrero 1 , MD Rincon 2 , S Garcia 2 , A Pumar 1 , A Leon 3 , JM Flores 2 , F Murillo 2 & A Leal-Cerro 1
1Department of Endocrinology, HH.UU Virgen del Rocío, Sevilla, Spain; 2Department of Critical Care, HH.UU Virgen del Rocío, Sevilla, Spain; 3Department of Laboratory, HH.UU Virgen del Rocío, Sevilla, Spain.
Introduction: Patients with severe cerebral Trauma are a risk population for developing hipopituytarism. Diagnosis of GHD need to study pituitary gland reserve with a stimulation test. Insulin Tolerance test (ITT) is the best standard test, although has important contraindication in these patients and its realization is not always a possible. We evaluate the diagnostic capacity of two alternative test (Glucagon Test an GHRH-GHRP6 test) and compared them with ITT.
Material and methods: In 52 adult patients with severe cerebral trauma (Glasgow < 8) occurred at least 12 month before study, we perform three consecutive test, with a minimum period of 72 hours among each other, in the following order: (1) Glucagon test. Glucagon 1 mg s.c with extractions at 90, 120, 150, 180, 210 and 240 minutes to determinate GH and glucose. (2) GHRH-GHRP-6 test. GHRH 100 mg and GHRP-6 100 mg, bolus i.v, and extractions in 0, 30, 60, 90 and 120 minutes to determinate GH. (3) ITT. Regular insulin 0.05–0.15 UI/Kg, bolus i.v and extractions in 0, 30, 60 minutes to determinate GH and Glucose, to get glucose level <40 mg/dl. In 10 patients ITT could not be done because of contraindications. GH values used for diagnosis of GHD are those published in de literature for each of these test. (Glucagon test, <3 mg/dl, GHRH-GHRP-6 <15 mg/dl and ITT < 3 mg/ml).
Results: 15/47 (31.91%) patients were diagnosticated of GHD with ITT, 8/58 (13.57%) patients were diagnosticated of GHD with GHRH-GHRP-6 test and 23/46 (41.07%) patients were diagnosticated of GHD with Glucagon test. Glucagon test sensitivity and specificity was 73.3%, Positive Predictive Value was 57.8% and Negative Predictive Value 84.61%, when we compared with ITT. GHRH-GHRP-6 test sensitivity was 40% and specificity was 100%, Positive Predictive Value was 100% and Negative Predictive Value 82.92%, when we compared with ITT.
Conclusions: Variability among three test is important. Glucagon test is not a good test since it has neither good sensitivity nor specificity. GHRP-GHRP-6 test is very specific, and may be valuable as confirmation test.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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