Dexamethasone Stimulation Test in the Diagnostic Work-Up of Growth Hormone Deficiency in Childhood: Clinical Value and Comparison With Insulin-Induced Hypoglycemia

• Published in: Frontiers in endocrinology (Lausanne) Vol. 11; p. 599302
• Main Authors: Cattoni, Alessandro, Molinari, Silvia, Medici, Francesco, De Lorenzo, Paola, Valsecchi, Maria Grazia, Masera, Nicoletta, Adavastro, Marta, Biondi, Andrea
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 09.12.2020
• Subjects: arginine stimulation test; dexamethasone stimulation test; Endocrinology; GH deficiency; human growth hormone; insulin tolerance test; GH deficiency; insulin tolerance test; dexamethasone stimulation test; human growth hormone; arginine stimulation test
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2020.599302

dexamethasone has been demonstrated to elicit GH secretion in adults, but few data are available about its effectiveness as a provocative in the diagnostic work-up of GH deficiency (GHD) in childhood. to assess the clinical value of dexamethasone stimulation test (DST) as a diagnostic tool for pediatric GHD. retrospective single-center analysis. The study population included 166 patients with a pathological response to arginine stimulation test (AST, first-line test) and subsequently tested with either insulin tolerance test (ITT) or DST as a second-line investigation between 2008 and 2019. comparison between GH peaks and secretory curves induced by ITT and DST; degree of agreement between DST and AST ITT and AST. the pathological response to AST (GH peak < 8 ng/mL) was confirmed by an ITT in 80.2% (89/111) of patients and by a DST in 76.4% (42/55), with no statistical difference between the two groups ( value 0.69). Mean GH peaks achieved after ITT and DST were entirely comparable (6.59 ± 3.59 6.50 ± 4.09 ng/ml, respectively, 0.97) and statistically higher than those elicited by arginine ( < 0.01 for both), irrespectively of the average GH peaks recorded for each patient (Bland-Altman method). Dexamethasone elicited a longer lasting and later secretory response than AST and ITT. No side effects were recorded after DST. DST and ITT confirmed GHD in a superimposable percentage of patients with a pathological first-line test. DST and ITT share a similar secretagogue potency, overall greater than AST.