Clinical Usefulness of the Growth Hormone-Releasing Peptide-2 Test for Hypothalamic-Pituitary Disorder.
Clinical Usefulness of the Growth Hormone-Releasing Peptide-2 Test for Hypothalamic-Pituitary Disorder.
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DOI：
10.1210/jendso/bvac088
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发表时间：
2022-08-01
影响因子：
4.1
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生长激素缺乏症(GHD)早期发生于下丘脑-垂体疾病患者，常伴有其他垂体前叶激素缺乏症，包括继发性肾上腺皮质功能不全(AI)。生长激素释放肽-2(GHRP2)试验被广泛用于GHD的诊断，被认为不仅可以诱导生长激素(GH)的释放，还可以诱导ACTH的释放。然而，它在治疗下丘脑-垂体疾病方面的临床应用尚不清楚。我们的目的是确定GHRP2测试在下丘脑-垂体疾病患者中的临床应用价值，特别是对伴有GHD的AI患者。对36例下丘脑-垂体疾病患者进行了GHRP2试验、促肾上腺皮质激素刺激试验、促肾上腺皮质激素释放激素(CRH)试验和/或胰岛素耐量试验(ITTS)。根据GHRP2，22例(61%)患有重度GHD，3例(8%)患有中度GHD。在非GHD、中度GHD和重度GHD参与者之间，基线ACTH和皮质醇水平没有差异。然而，促肾上腺皮质激素刺激试验和随后的CRH试验和/或ITTS显示17例(47%)有继发性AI，16/17例(94%)继发性AI伴有严重的GHD。ROC曲线分析表明，GHRP2试验中的ACTH反应可用于筛选垂体AI，其临界值为1.55倍(敏感性为83%，特异性为88%)。值得注意的是，ACTH反应和GHRP2试验中峰值皮质醇水平的组合使用每个临界值(分别为1.55倍和10µg/dL)，对诊断垂体型AI显示出高特异度(100%)和高准确度(0.94)。我们建议在GHRP2测试中测量ACTH和GH，以避免忽视或延误经常伴随GHD的继发性AI的诊断。
Growth hormone deficiency (GHD) develops early in patients with hypothalamic-pituitary disorder and is frequently accompanied by other anterior pituitary hormone deficiencies, including secondary adrenal insufficiency (AI). A growth hormone–releasing peptide-2 (GHRP2) test, which is widely used for the diagnosis of patients with GHD, is thought to induce release of not only growth hormone (GH) but also ACTH. However, its clinical usefulness in hypothalamic-pituitary disorder is unclear. We aimed to determine the clinical utility of the GHRP2 test in patients with hypothalamic-pituitary disorders, particularly for AI concomitant with GHD. The GHRP2 test, a cosyntropin stimulation test, corticotropin-releasing hormone (CRH) tests, and/or insulin tolerance tests (ITTs) were performed on 36 patients with hypothalamic-pituitary disorder. Twenty-two (61%) had severe GHD, and 3 (8%) had moderate GHD by GHRP2. There was no difference in baseline ACTH and cortisol between non-GHD, moderate GHD, and severe GHD participants. However, a cosyntropin stimulation test and subsequent CRH tests and/or ITTs revealed that 17 (47%) had secondary AI and 16/17 (94%) cases of secondary AI were concomitant with severe GHD. ROC curve analysis demonstrated that the ACTH response in the GHRP2 test was useful for screening pituitary-AI, with a cutoff value of 1.55-fold (83% sensitivity and 88% specificity). Notably, the combination of ACTH response and the peak cortisol level in the GHRP2 test using each cutoff value (1.55-fold and 10 µg/dL, respectively) showed high specificity (100%) with high accuracy (0.94) for diagnosis of pituitary-AI. We recommend measuring ACTH as well as GH during the GHRP2 test to avoid overlooking or delaying diagnosis of secondary AI that frequently accompanies GHD.