Comparison of insulin tolerance test and arginine test in the diagnosis of growth hormone deficiency in children

초록

Background: The diagnosis of growth hormone deficiency (GHD) requires the subnormal responses to two provocation tests. This study evaluated the value of the growth hormone provocation test using arginine and insulin-induced hypoglycemia to diagnose growth hormone deficiency (GHD). Method: This study included 294 children with short stature (136 girls and 158 boys) who underwent a growth hormone provocation test using the arginine test (AT) and insulin tolerance test (ITT). Results: The age at the time of evaluation was 7.6 ± 3.0 years, and GHD and partial GHD were diagnosed in 42 and 111 patients, respectively. Weight-SDS and BMI-SDS were significantly higher in the GHD and partial GHD groups (1.52 ± 1.07 vs. -1.64 ± 0.84 vs. -2.0 ± 0.89, P= 0.001; 0.13 ± 1.07 vs. -1.64 ± 0.84 vs. -2.01 ± 0.89, P= 0.001) and IGFBP3 was lower in the GHD group (1742.4 ± 500.4 vs. 1843.7 ± 410.3 vs. 1967.8 ± 498.6, P= 0.011) than in the non-GHD group. Thirty patients showed peak growth hormone levels > 10 ng/mL in both provocation tests, 35 in ITT alone, and 72 in AT alone. Hypoglycemia was not induced in three patients, and one patient showed anaphylaxis due to arginine administration. The specificity and accuracy of AT were 74.8% and 88.0%, respectively, while the specificity and accuracy of ITT were 48.8% and 75.3%, respectively. Conclusion: The higher specificity and accuracy of AT compared to ITT suggests that it would be beneficial to perform AT as an initial evaluation of the growth hormone axis in children with short stature.