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Cited by 45Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsHypothalamic control of reproductive hormones

Effect of obesity and morbid obesity on the growth hormone (GH) secretion elicited by the combined GHRH + GHRP-6 test

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Kelestimur, Fahrettin, Popovic, Vera, Leal, Alfonso, Van Dam, P. Sytze, Torres, Elena, Perez Mendez, Luisa F., Greenman, Yona, Koppeschaar, Hans P. F. +2 more·2006·Clinical Endocrinology
DOI 10.1111/j.1365-2265.2006.02525.x
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Abstract

Summary: Objective Obesity is characterized by low basal levels of growth hormone (GH) and impeded GH release. However, the main problem arises in the diagnosis of GH deficiency in adults, as all accepted cut‐offs in the diagnostic tests of GH reserve are no longer valid in obese subjects. In this work, the role of obesity in the GH response elicited by the GHRH + GHRP‐6 test was assessed in a large population of obese and nonobese subjects. Patients GHRH + GHRP‐6‐induced GH peaks were evaluated in 542 subjects. One hundred and five were healthy obese, 50 were morbid obese, and 261 were nonobese (both normal weight and overweight). One hundred and seventy‐six GH‐deficient patients (obese and nonobese) were also studied. Results A regression analysis of the 366 subjects with normal pituitary function indicated that adiposity had a negative effect on the elicited GH peak (r = –0·503, P < 0·0001). A receiver operating characteristic (ROC) curve analysis showed that in subjects with a BMI 35, the currently accepted cut‐offs of the GHRH + GHRP‐6 test (GH peaks 20 µg/l: normal secretion; GH peaks 10 µg/l: GH deficiency), were fully operative. However, in subjects with a BMI > 35, normality was indicated by GH peaks 15 µg/l and GH deficiency by peaks 5 µg/l (1 µg/l = 2·6 mU/l). Conclusions This study confirms: (a) that the combined provocative test is adequate to separate normal and GH‐deficient subjects; (b) the negative effect of obesity on GH secretion; (c) that obesity accounts for 25% of the reduction of GH release; and (d) that present cut‐off values are applicable to normal weight, overweight and grade I obesity subjects, whereas in obese subjects with a BMI exceeding 35, all the normative limits of the GHRH‐GHRP +6 test must be reduced by 5 µg/l.

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  • The GHRH+GHRP-6 test has a BMI-dependent cutoff (15 and 5 ug/L for lean and obese subjects with BMI >35 kg/m2) and great accuracy in distinguishing normal subjects from patients with GHD.

    “Another potent and validated provocative test is the GHRHϩGHRP-6 test (224, 225).It has a BMI-dependent cutoff (15 and 5 g/L for lean and obese subjects with BMI Ͼ 35 kg/m 2 , respectively) and possesses great accuracy in distinguishing normal subjects from patients with GHD (224, 225).”

    From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [224]

    The Discussion reports BMI-dependent cutoffs and describes the test as validated; the Results compare its ability to distinguish controls from patients with GHD. But the quoted values are assigned incorrectly: for BMI >35, 15 µg/L indicates normal secretion and 5 µg/L indicates deficiency. For BMI ≤35, the corresponding cutoffs are 20 and 10 µg/L, and intermediate results are inconclusive. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [10]10. Growth Hormone Research Society (1998) Consensus guidelines for the diagnosis and treatment of adults with growth hormone defi- ciency. Journal of Clinical Endocrinology and Metabolism, 83, 379- 381.

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Authors
Kelestimur, F., Popovic, V., Leal, A., Van Dam, P. S., Torres, E., Perez Mendez, L. F., Greenman, Y., Koppeschaar, H. P. F., Dieguez, C., & Casanueva, F. F.
Affiliations
  • University of Belgrade (RS)
  • Hospital Universitario Virgen del Rocío (ES)
  • Complejo Hospitalario Universitario de Granada (ES)
  • Tel Aviv Sourasky Medical Center (IL)
  • Universidade de Santiago de Compostela (ES)
Corresponding author
Casanueva, Felipe F.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2006-04-20
Volume
64
Issue
6
Pages
667-671
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/j.1365-2265.2006.02525.x
OpenAlex
W2032738647
Semantic Scholar
7d10edec383b8a415634624406da4c45ee405b6d
Cited by
45
References
38
Citations by year
2026: 1 · 2024: 2 · 2023: 2 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 1 · 2015: 7 · 2014: 1 · 2013: 3 · 2012: 3
FWCI
2.94
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Xunta de Galicia
  • Instituto de Salud Carlos III (C03/08, C03/01)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
Keywords
obesity, morbid obesity, growth hormone secretion, growth hormone deficiency, diagnostic thresholds, adiposity, body mass index, pituitary function
MeSH terms
Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Obesity, Obesity, Morbid, Oligopeptides, Predictive Value of Tests, Regression Analysis, ROC Curve, Growth Hormone, Growth Hormone-Releasing Hormone, Case-Control Studies

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