The diagnosis of GH deficiency in obese patients: a reappraisal with GHRH plus arginine testing after pharmacological blockade of lipolysis.

  title={The diagnosis of GH deficiency in obese patients: a reappraisal with GHRH plus arginine testing after pharmacological blockade of lipolysis.},
  author={Massimo Scacchi and Federica Orsini and Agnese Cattaneo and Alice Grasso and B{\'a}rbara Filippini and Francesca Pecori Giraldi and Letizia Maria Fatti and Mirella Moro and Francesco Cavagnini},
  journal={European journal of endocrinology},
  volume={163 2},
BACKGROUND The diagnosis of GH deficiency (GHD) in obese patients is complicated by the reduced GH secretion associated with overweight. A GH response to GHRH+arginine lower than 4.2 microg/l is currently considered indicative of GHD in obesity. The aim of the study was to investigate the effect of acute pharmacological blockade of lipolysis on the GH response to GHRH+arginine in obese patients. PATIENTS AND METHODS Two groups of patients were studied: 12 obese patients with proven GHD and 14… 

Figures and Tables from this paper

Prevalence of growth hormone deficiency in middle-age adults recovering from stroke

Evidence suggests patients with stroke may be at risk for developing chronic growth hormone deficiency, and co-morbidities for stroke and neuroendocrine dysfunction overlap and may have implications for recovery following stroke.

The robustness of diagnostic tests for GH deficiency in adults.

  • M. Andersen
  • Medicine, Biology
    Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society
  • 2015

Hypothalamic Growth Hormone/IGF-1 Axis

The impairment of GH/IGF-1 axis might be the rationale to consider GH as an adjunctive treatment of obesity, at least in the subset of obese individuals with reduced GH secretory capacity and low circulating levels of IGF-1, in relation to their worse cardiometabolic risk profile, with particular regard to those patients who are candidates for bariatric surgery.

Influence of Body Mass Index on the Growth Hormone Response to Provocative Testing in Short Children without Growth Hormone Deficiency

In children without GH deficiency, BMI SDS correlates negatively with the peak GH level, and should be included in the analysis of the results of GH provocation tests, especially tests with clonidine.

The complex relationship between obesity and the somatropic axis: the long and winding road.

Contribution of Ghrelin to the Pathogenesis of Growth Hormone Deficiency

The latest attempts to use the GH secretagogue receptor (GHS-R) analogues for possible diagnostic and therapeutic purposes and the mutual relationships between ghrelin and the TSH-FT4/FT3 axis in growth and metabolic processes are described.

A review of the cardiovascular and anti-atherogenic effects of ghrelin.

The current literature focusing on ghrelin as a potential antiatherogenic agent in the treatment of various pathophysiological conditions is considered and it is assumed that blood glucose levels represent a significant regulator.

Prevalence of pituitary hormone dysfunction, metabolic syndrome, and impaired quality of life in retired professional football players: a prospective study.

It is suggested that GHD and hypogonadism may contribute to poor QoL, erectile dysfunction, and MetS in this population of retired NFL players with poor quality of life and pituitary and metabolic function.



Effect of acute pharmacological reduction of plasma free fatty acids on growth hormone (GH) releasing hormone-induced GH secretion in obese adults with and without hypopituitarism.

GH secretion, after GHRH-plus-acipimox administration, is reduced in obese adults with hypopituitarism patients, when compared with obese normal patients, and could be used for the diagnosis of GHD in adults.

Assessment of GH/IGF-I axis in obesity by evaluation of IGF-I levels and the GH response to GHRH+arginine test

It is confirmed that the secretory capacity of somatotroph cells is often deeply impaired in obesity and IGF-I assay generally rules out severe impairment of GH/IGF-I axis in obese patients with marked reduction of the GH secretion.

The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index.

The GHRH-ARG test is a reliable tool for the diagnosis of adult GH deficiency in lean, overweight and obese patients, provided that specific BMI-related cut-off limits are assumed.

Comparison between insulin tolerance test, growth hormone (GH)-releasing hormone (GHRH), GHRH plus acipimox and GHRH plus GH-releasing peptide-6 for the diagnosis of adult GH deficiency in normal subjects, obese and hypopituitary patients.

The aim of the present study was to evaluate the diagnostic capability of four different stimuli of GH secretion: ITT, GHRH, G HRH plus acipimox (GHRH+Ac), and GHRh plus GHRP-6 (G HRH+GHRP -6), in two pathophysiological situations: hypopituitarism and obesity, and normal subjects.

Restoration of growth hormone (GH) response to GH-releasing hormone in elderly and obese subjects by acute pharmacological reduction of plasma free fatty acids.

The data indicate that acute pharmacological reduction of plasma FFA levels restores the blunted GH response to GHRH commonly observed in obese and elderly subjects: however, when lipolysis is blocked to a similar extent, healthy subjects still show a higher GH delta area than obese or elderly subjects.

Maximal secretory capacity of somatotrope cells in obesity: comparison with GH deficiency

The maximal secretory capacity of somatotrope cells is clearly less than normal in the obese but still more than is seen in GHD subjects, however, in about 50% of obese patients, the pituitary GH releasable pool overlaps with that of hypopituitaric patients with GH deficiency.

Acipimox potentiates growth hormone (GH) response to GH-releasing hormone with or without pyridostigmine by lowering serum free fatty acid in normal and obese subjects.

  • E. LeeS. Nam K. Huh
  • Medicine, Biology
    The Journal of clinical endocrinology and metabolism
  • 1995
The results are in agreement with the hypothalamic hypothesis: an increase in somatostatinergic tone is responsible for the blunted GH response to GHRH in obesity.

Impaired growth hormone secretion in obese subjects is partially reversed by acipimox-mediated plasma free fatty acid depression.

The results indicate that in obese subjects, unlike normal weight subjects, FFA reduction per se does not stimulate GH secretion, and the abnormally high FFA levels may be a contributing factor for the disrupted GH secretory mechanisms in obesity.