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Cited by 117Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsHypothalamic control of reproductive hormones

Body mass index determines evoked growth hormone (GH) responsiveness in normal healthy male subjects: diagnostic caveat for adult GH deficiency

Bonert, Vivien S., Elashoff, Janet D., Barnett, Philip, Melmed, Shlomo·2004·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/jc.2003-032213
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Abstract

GH secretion is decreased in obese subjects, whereas age-adjusted IGF-I concentrations are normal. This study was undertaken to rigorously delineate the extent of obesity [elevated body mass index (BMI)] associated with decreased somatotrope secretory function resulting in apparent adult GH deficiency. The peak GH response evoked by combined arginine (0.5 g/kg infused iv over 30 min) and GHRH (1 μg/kg iv bolus) was measured in 59 healthy male subjects with BMIs ranging from normal to obese. BMI correlated with the peak evoked GH response (Pearson r = −0.59; P < 0.01), and the percentage of subjects exhibiting an abnormal evoked GH response, i.e. less than 9 ng/ml, increased from 5% for those with a BMI less than 25 (normal), to 13% for those with a BMI of 25–26.9 (mildly overweight), to 33% for those with a BMI of 27–29.9 (moderately overweight), and to 64% for those with a BMI of 30 or more (obese). BMI is a major determinant of evoked adult GH response to provocative testing. The diagnosis of adult GH deficiency using the evoked GH response in patients with even mild BMI elevation does not accurately distinguish normal from deficient responses and may result in the erroneous classification of obese subjects as GH deficient and thus unnecessarily requiring GH replacement.

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  • The GH response to GHRH+ARG and to all known GH provocative stimuli significantly declines with increasing BMI in adults.

    “However, the GH response to GHRHϩARG, and to all known GH provocative stimuli, significantly declines with increasing BMI in adults (221, 222); thus, the use of a non-BMI-related cutoff in obese subjects causes a high percentage of false-positive results (203).”

    From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [221]

    The Results (p. 2) report a significant inverse correlation between BMI and GH response to arginine-GHRH in 59 healthy men. The Discussion (p. 3) also says BMI relates inversely to responses to insulin tolerance testing, but the paper does not establish a decline for all known GH provocative stimuli or for adults generally. (LLM, conf=0.88)

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Authors
Bonert, V. S., Elashoff, J. D., Barnett, P., & Melmed, S.
Affiliations
Cedars-Sinai Medical Center (US)
Corresponding author
Melmed, Shlomo
ORCID
Melmed, Shlomo
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2004-07-01
Volume
89
Issue
7
Pages
3397-3401
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/jc.2003-032213
OpenAlex
W2077882762
Semantic Scholar
04faa9590eb74151571ede7ccd843eecfcee62d9
Cited by
117
References
51
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 7 · 2014: 4 · 2013: 7 · 2012: 7
FWCI
7.85
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Eli Lilly and Company
  • National Cancer Institute (R01CA075979, CA-75979)
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
adult growth hormone deficiency, body mass index, obesity, arginine stimulation, GHRH stimulation, provocation tests, insulin-like growth factor I, growth hormone replacement therapy, diagnostic accuracy
MeSH terms
Adult, Aging, Arginine, Humans, Insulin-Like Growth Factor I, Male, Middle Aged, Obesity, Growth Hormone-Releasing Hormone, Time Factors, Body Mass Index, Case-Control Studies, Human Growth Hormone

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