Pituitary function assessment in short stature by a combined hormonal-stimulation test
M. Pugliese, F. Lifshitz, P. Fort, C. Cervantes, B. Recker and L. Ginsberg
We utilized a combined, hormonal-stimulation test (CHST) using
sequentially-administered insulin, thyrotropin-releasing hormone,
gonadotropin-releasing hormone, and levodopa to assess 51 children with
short stature and/or pathologic growth. Growth hormone, thyrotropin,
gonadotropins, cortisol, and prolactin levels were sampled over two hours.
All patients with appropriate predicted adult heights, delayed bone ages,
and normal growth velocities of 4.0 cm/y or greater demonstrated normal
pituitary responses. Two of 12 patients with predicted heights 2.5 SDs
lower than target height and normal growth velocity demonstrated isolated
growth hormone deficiency. Nine of 11 patients had a pathologic growth
hormone deficiency or panhypopituitarism. Evaluation of pituitary function
by combined sequential hormonal stimulation is fruitful in children with
pathologic growth patterns but not in children with normal growth
velocities and normal predicted adult height.
