ECE2009 Poster Presentations Neuroendocrinology, Pituitary and Behaviour (74 abstracts)
Ghrelin as new provocative test for the diagnosis of GH deficiency in adults
Valentina Gasco 1 , Silvia Rovere 1 , Guglielmo Beccuti 1 , Fabio Broglio 1 , Gianluca Aimaretti 2 , Silvia Grottoli 1 , Felipe Casanueva 3 & Ezio Ghigo 1
1Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy; 2Endocrinology, Department of Clinical and Experimental Medicine, University of Eastern Piedmont, Novara, Italy; 3Endocrine Division, Department of Medicine, Santiago de Compostela University, Santiago de Compostela, Spain.
ITT is the test of reference for the diagnosis of adult GH deficiency (GHD), but it is recognized that also GHRH in combination with arginine (ARG) or GH secretagogues (GHS) are equally reliable tests. It has also been suggested that testing with GHS would represent a potent stimulus exploring also the integrity of hypothalamic pathways controlling somatotropic function. We therefore aimed to clarify the diagnostic reliability of testing with ghrelin, the natural GHS. We studied the GH response (every 15 min from −15 to +120 min) to acylated ghrelin (1 μg/kg i.v. at 0 min) in 42 patients with history of pituitary disease (HYPOPIT, 34 M, 8 F; age (mean±S.D.): 49.3±19.3 years; BMI: 26.9±5.6 kg/m2). As gold standard for the diagnosis of GHD we assumed the lack of GH response to GHRH+ARG and/or the lack of GH response to ITT. We tried to identify the best GH cut-off to ghrelin test, defined as the one with the best sensitivity and specificity, using the Receiver-Operating Characteristic Curve (R.O.C.) analysis. The GH response to ghrelin in GHD patients was lower than that in noGHD (3.0±4.7 vs 18.9±12.9 μg/l, P<0.00005). The GH response to ghrelin was similar to that after GHRH+ARG both in GHD (3.7±2.8 μg/l) and in noGHD (19.9±9.6 μg/l) but clearly higher than that elicited by ITT (GHD: 1.3±1.3 μg/l, P< 0.05; noGHD: 10.4±8.7 μg/l). The best GH cut-off to gherlin test was 3.2 μg/l, with a sensibility and specificity value of 80.6 and 90.9%, respectively, with a diagnostic accuracy of 83.3%. In conclusion, these preliminary results indicate that testing with acylated ghrelin would represent a reliable diagnostic tool for the diagnosis of adult GHD.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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