Provocative growth hormone testing in children: how did we get here and where do we go now?
Provocative growth hormone testing in children: how did we get here and where do we go now?
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DOI：
10.1515/jpem-2021-0045
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发表时间：
2021-06-25
期刊：
影响因子：
--
通讯作者：
Grimberg A
中科院分区：
文献类型：
--
作者：
Kamoun C;Hawkes CP;Grimberg A
激发生长激素 (GH) 试验广泛用于诊断儿童 GH 缺乏症 (GHD)。彻底了解常用解释背后的证据和这些测试的局限性对于改善临床实践非常重要。为了将当前实践置于历史背景中，提出了使用激发性 GH 测试背后的支持证据。通过审查 GH 测量技术并检查支持最常见测试的早期数据以及比较激发剂以建立参考范围的后期研究，这些测试的低敏感性和特异性变得显而易见。评估肥胖和性类固醇等患者因素对 GH 检测影响的研究进一步对诊断 GHD 常用的临界值的适当性提出了质疑。尽管人们普遍认为激发性 GH 测试在区分 GH 充足与缺乏方面表现不佳，但在改进方面取得的进展有限。需要新的诊断方式，但在它们可用之前，临床医生可以通过考虑影响其结果的多种因素来改进激发性 GH 测试的临床应用。
Provocative growth hormone (GH) tests are widely used for diagnosing pediatric GH deficiency (GHD). A thorough understanding of the evidence behind commonly used interpretations and the limitations of these tests is important for improving clinical practice. To place current practice into historical context, the supporting evidence behind the use of provocative GH tests is presented. By reviewing GH measurement techniques and examining the early data supporting the most common tests and later studies that compared provocative agents to establish reference ranges, the low sensitivity and specificity of these tests become readily apparent. Studies that assess the effects of patient factors, like obesity and sex steroids, on GH testing further bring the appropriateness of commonly used cutoffs for diagnosing GHD into question. Despite the widely recognized poor performance of provocative GH tests in distinguishing GH sufficiency from deficiency, limited progress has been made in improving them. New diagnostic modalities are needed, but until they become available, clinicians can improve the clinical application of provocative GH tests by taking into account the multiple factors that influence their results.
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影响因子：
5.1
作者：
DONALDSON, DL;HOLLOWELL, JG;MOORE, WV
通讯作者：
MOORE, WV
影响因子：
4.1
作者：
BANGHAM, DR;DAS, REG;SCHULSTER, D
通讯作者：
SCHULSTER, D
影响因子：
--
作者：
Bristow, AF
通讯作者：
Bristow, AF
影响因子：
3.1
作者：
DELLER, JJ;BOULIS, MW;LINFOOT, JA
通讯作者：
LINFOOT, JA
影响因子：
2.4
作者：
Duche, Laetitia;Trivin, Christine;Chemaitilly, Wassim;Souberbielle, Jean Claude;Breart, Gerard;Brauner, Raja;Chalumeau, Martin
通讯作者：
Chalumeau, Martin