Sex steroid priming for growth hormone stimulation testing in children and adolescents with short stature: A systematic review.
Sex steroid priming for growth hormone stimulation testing in children and adolescents with short stature: A systematic review.
复制标题
身材矮小儿童和青少年生长激素刺激试验的性类固醇启动：系统评价。
DOI：
10.1111/cen.14862
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发表时间：
2023
影响因子：
3.2
通讯作者：
Duncan G
中科院分区：
文献类型：
--
作者：
Duncan G
目的生长激素刺激试验(GHST)用于诊断儿童生长激素缺乏症(GHD)。由于性类固醇对垂体前叶功能的影响，在内源性类固醇水平较低的青春期儿童中，GHST的疗效受到关注。在GHST之前，性激素激发被认为可以提高这些儿童的测试效率，然而，支持其在临床实践中使用的证据有限。在这篇系统的综述中，我们解决了以下研究问题：在青春期周围儿童中，启动是否提高了GH刺激测试的效率？就最终身高而言，启动是否确定了那些将从治疗中受益最大的人？是否有证据表明最佳的性激素注射方案？设计、患者、测量该研究已在PROSPERO注册，并根据PRISMA指南进行。我们检索了Medline、Cochrane-Library、Scope us、EMBASE和Web-of Science，并收录了包括孕酮催产素在内的所有研究。以7 /L作为生长激素缺乏症的临界值。结果15项研究符合我们的纳入标准，其中4/15(27%)为随机对照试验。大多数(9/15)的研究表明，在青春期前后的儿童中，预充剂增加了生长激素对生长激素的反应，提高了测试的特异性。两项研究调查了治疗后的最终身高，这两项研究是基于预充与未预充的GHST的结果。这些结果表明，与基于非启动试验的治疗相比，基于启动的GHST结果的生长激素治疗改善了预后。结论性激素启动增加了GHST期间的生长激素反应，导致更少的患者达到诊断GHD的阈值。在一些患者中，可以避免不必要的生长激素治疗，而不会对最终身高产生不利影响。许多性激素激发方案已经在临床实践中使用，大多数似乎是有效的，但还没有确定最佳方案。
ObjectiveGrowth 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.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‐steroid priming regimen?Design, Patients, MeasurementsThe study was registered with PROSPERO and conducted according to PRISMA guidelines. We searched Medline, Cochrane‐Library, Scopus, EMBASE and Web‐of‐Science and included all studies that included GHST in both primed and unprimed children. A GH cut‐off of 7 µg/L was used as a threshold for GHD. Study quality was assessed using the Risk‐Of‐Bias in Non‐ Randomized Studies (ROBINS‐I) tool or the revised Cochrane risk‐of‐bias tool for Randomised trials.ResultsFifteen 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.ConclusionSex‐steroid 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‐steroid priming regimens have been used in clinical practice and the majority appear to be effective, but an optimal regimen has not been determined.