Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how
Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpre...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-11-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2022.1072271/full |
| _version_ | 1811215301371494400 |
|---|---|
| author | Cristina Partenope Elena Galazzi Assunta Albanese Simonetta Bellone Ivana Rabbone Luca Persani Luca Persani |
| author_facet | Cristina Partenope Elena Galazzi Assunta Albanese Simonetta Bellone Ivana Rabbone Luca Persani Luca Persani |
| author_sort | Cristina Partenope |
| collection | DOAJ |
| description | Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age. |
| first_indexed | 2024-04-12T06:20:34Z |
| format | Article |
| id | doaj.art-86147f89d2df4311b03f870e3f4a03df |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-04-12T06:20:34Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-86147f89d2df4311b03f870e3f4a03df2022-12-22T03:44:21ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922022-11-011310.3389/fendo.2022.10722711072271Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and howCristina Partenope0Elena Galazzi1Assunta Albanese2Simonetta Bellone3Ivana Rabbone4Luca Persani5Luca Persani6Division of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, ItalyDepartment of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, ItalyDepartment of Paediatric Endocrinology, St. George’s University Hospital NHS Foundation Trust, London, United KingdomDivision of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, ItalyDivision of Pediatrics, Department of Health Science University of Piemonte Orientale, Ospedale Maggiore della Carità, Novara, ItalyDepartment of Endocrinology and Metabolic Diseases, Istituto Auxologico Italiano IRCCS, Milan, ItalyDepartment of Medical Biotechnology and Translational Medicine, University of Milan, Milan, ItalyDespite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.https://www.frontiersin.org/articles/10.3389/fendo.2022.1072271/fullpubertal delaysex steroid primingGH deficiency (GHD)short statureperipubertal agegrowth hormone stimulation test (GHST) |
| spellingShingle | Cristina Partenope Elena Galazzi Assunta Albanese Simonetta Bellone Ivana Rabbone Luca Persani Luca Persani Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how Frontiers in Endocrinology pubertal delay sex steroid priming GH deficiency (GHD) short stature peripubertal age growth hormone stimulation test (GHST) |
| title | Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how |
| title_full | Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how |
| title_fullStr | Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how |
| title_full_unstemmed | Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how |
| title_short | Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how |
| title_sort | sex steroid priming in short stature children unresponsive to gh stimulation tests why who when and how |
| topic | pubertal delay sex steroid priming GH deficiency (GHD) short stature peripubertal age growth hormone stimulation test (GHST) |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2022.1072271/full |
| work_keys_str_mv | AT cristinapartenope sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT elenagalazzi sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT assuntaalbanese sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT simonettabellone sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT ivanarabbone sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT lucapersani sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow AT lucapersani sexsteroidpriminginshortstaturechildrenunresponsivetoghstimulationtestswhywhowhenandhow |