Diagnosis of GH Deficiency as a Late Effect of Radiotherapy in Survivors of Childhood Cancers
| Autor: | Shrikant Tamhane, M. Hassan Murad, Wassim Chemaitilly, Nana Esi Kittah, Laurie E. Cohen, Jad G Sfeir, Sina Jasim |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Pediatrics Endocrinology Diabetes and Metabolism Clinical Biochemistry Population MEDLINE 030209 endocrinology & metabolism Biochemistry Diagnostic Techniques Endocrine 03 medical and health sciences 0302 clinical medicine Endocrinology Cancer Survivors Predictive Value of Tests Internal medicine medicine Humans Age of Onset Child Radiation Injuries education Growth Disorders education.field_of_study Radiotherapy Human Growth Hormone business.industry Biochemistry (medical) Insulin tolerance test Late effect Reproducibility of Results Systematic review 030220 oncology & carcinogenesis Predictive value of tests Cohort Age of onset medicine.symptom business |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 103:2785-2793 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/jc.2018-01204 |
| Popis: | Background Limited guidance exists for selecting a laboratory method for diagnosing GH deficiency (GHD) when it occurs as a late effect of radiotherapy in childhood cancer survivors (CCSs). Methods We searched Medline, Embase, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, and Scopus for studies evaluating GHD that used IGF-1 or IGF-binding protein 3 (IGFBP-3) measurements compared with GH dynamic testing. Results We included 15 studies [IGF-1 (8 studies) and IGFBP-3 (7 studies)] enrolling 477 patients. Comparator tests varied widely. Overall, both IGF-1 and IGFBP-3 had suboptimal diagnostic accuracy but were strongly correlated. The use of both tests simultaneously in the same cohort did not improve the diagnostic accuracy. Despite high variability in the testing protocols, dynamic tests remained the most accurate for appropriately identifying patients with GHD. The insulin tolerance test (ITT) appears to be the most accepted reference test when used alone or in combination with arginine; however, standardized testing strategies among practice groups are absent. GHRH and arginine stimulation performed almost similarly to the ITT; however, in one study GHRH with arginine stimulation had 66% sensitivity and 88% specificity compared with the ITT. Insufficient data were available to assess the accuracy of serial GH testing (nocturnal or over 24 hours). Conclusion The diagnostic accuracy of various dynamic tests for GHD in CCSs appears to follow the same patterns as those in non-CCSs. Interpreting GHRH stimulation is a challenge given the primarily hypothalamic dysfunction in CCSs. IGF-1 and IGFBP-3 perform poorly in this population. |
| Databáze: | OpenAIRE |
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