Consensus and controversies about diagnosing GH deficiency: a Delphi survey by the GH research society.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2025-05-07 DOI:10.1007/s11102-025-01526-z

M C Arlien-Søborg, S Radovick, M C S Boguszewski, M Bidlingmaier, G Johannsson, A Grimberg, K K Y Ho, B M K Biller, C S Choong, A R Hoffman, P Backeljauw, C L Boguszewski, J Bollerslev, T Brue, P Chanson, E Christ, S Cianfarani, P E Clayton, P Cohen, A Dauber, M Fleseriu, J Gebauer, A Giustina, C E Higham, R Horikawa, C Höybye, A Juul, M Lodish, X Luo, N Mauras, K K Miller, S Melmed, S J C M M Neggers, N Karavitaki, R Rosenfeld, R Ross, L Savendahl, K Schilbach, P F Collett-Solberg, C J Strasburger, N A Tritos, H M van Santen, K C J Yuen, J O L Jorgensen

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引用次数: 0

Abstract

Purpose: Biochemical tests are required for diagnosing GH-deficiency in children and adults, but controversies remain regarding diagnostic criteria and type of biochemical tests. The aim of the study is to map the clinical practices of GHD diagnosis in children and adults.

Methods: The Growth Hormone Research Society members initiated a Delphi survey of the diagnosis of GHD in children and adults. Pediatric (n = 18) and adult (n = 25) endocrinologists from 14 countries participated and rated their extent of agreement with 61 statements using a Likert-type-scale (1-7). Consensus was predefined as ≥ 80% of panelists rating their agreement unidirectionally as either ≥ 5 (agreement) or ≤ 3 (disagreement).

Results: The pediatric panel reached consensus on 17 of 29 (59%) statements on diagnosis in children, whereas the adult panel reached consensus on 28 of 32 (88%) statements on adult patients. There was general agreement to test for GHD in an appropriate clinical context and also on the timing of testing for GHD in both children and adults. A subnormal IGF-I level was considered diagnostic in both children and adults with panhypopituitarism. In children, there was consensus to recommend the arginine stimulation test and the glucagon test. The insulin tolerance test (ITT) was considered gold standard in adults and there was also consensus to recommend the macimorelin test. A stimulated GH cut-off < 5μg/l was consistent with severe GHD in children, whereas test-specific cut-offs were recommended in adults.

Conclusion: Consensus on the GHD diagnosis was lower in pediatric practice, mainly with respect to choice and interpretation of GH stimulation tests.

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关于生长激素缺乏症诊断的共识与争议：生长激素研究协会的德尔菲调查。

目的：诊断儿童和成人gh缺乏症需要生化试验，但关于诊断标准和生化试验类型仍存在争议。该研究的目的是绘制儿童和成人GHD诊断的临床实践图。方法：生长激素研究学会成员发起了儿童和成人GHD诊断的德尔菲调查。来自14个国家的儿科（n = 18）和成人（n = 25）内分泌学家参与了这项研究，并使用李克特类型量表（1-7）对61项陈述的同意程度进行了评分。共识被预先定义为≥80%的专家组成员单向地将他们的共识评为≥5（同意）或≤3（不同意）。结果：儿童小组对儿童诊断的29项陈述中有17项（59%）达成共识，而成人小组对成人患者的32项陈述中有28项（88%）达成共识。人们普遍同意在适当的临床环境下检测GHD，也同意在儿童和成人中检测GHD的时间。igf - 1水平低于正常被认为是儿童和成人全垂体功能减退症的诊断。在儿童中，普遍推荐精氨酸刺激试验和胰高血糖素试验。胰岛素耐量试验（ITT）被认为是成人的金标准，同时也有一致的意见推荐马西莫瑞林试验。结论：在儿科实践中，对GHD诊断的共识较低，主要是关于GH刺激试验的选择和解释。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.