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P9 Ghrelin test: a new tool for the diagnosis of GH deficiency in adults
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Poster Presentations / Growth Hormone & IGF Research 20 (2010) S39–S81
patients with acromegaly. Basal serum TSH, free T4 and free T3 concentrations and ultrasound findings in 60 patients with newly diagnosed acromegaly (M/F 25/35, age range: 21–86 years old) including one patient with GH/TSH producing pituitary adenoma were studied. Median serum free T3 , free T4 and TSH levels were 3.15 pg/ml (range: 1.10–5.34, normal: 2.4–4.0), 1.25 ng/dl (range: 0.89–1.78, normal: 0.94–1.60) and 0.75 mU/ml (range: <0.005–4.02, normal: 0.38–4.30), respectively. Basal serum TSH levels were lower than the lower limit of normal range without elevated freeT3 or free T4 levels in 12 of 60 (20%) patients. Anti-thyroglobulin and antimicrosomal antibodies were measured in 20 patients. Titers of these antibodies were positive in 4 patients. Thyroid ultrasonography was performed in 54 patients. Adenomatous nodules, multinodular goiter and papillary thyroid cancer were revealed in 25 (46%), 16 (30%) and 2 patients. Furthermore, there was one patient who had an episode of thyroidectomy due to a papillary thyroid cancer 6 months before the diagnosis of acromegaly. In conclusion, thyroid function was normal in most patients with acromegaly, but basal TSH decreased in 20% of the patients. One mechanism for suppressed serum TSH levels is presumably due to the activation of somatostatin release driven by GH excess. The association of thyroid cancer was observed in 5% of the patients, indicating that a screening of thyroid gland using ultrasonograpy is recommended at least once in patients with acromegaly. P9 Ghrelin test: a new tool for the diagnosis of GH deficiency in adults V. Gasco1 , F. Marotta2 , G. Beccuti2 , S. Grottoli2 , E. Ghigo2 . 1 Department of Internal Medicine, Division of Endocrinology and Metabolism., University of Turin, Turin, Italy; 2 Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Turin, Turin, Italy ITT is the test of reference for the diagnosis of adult GH deficiency (GHD), but it is recognized that also GHRH in combination with arginine (ARG) or GH secretagogues (GHS) are equally reliable tests. It has also been suggested that testing with GHS would represent a potent stimulus exploring also the integrity of hypothalamic pathways controlling somatotropic function. We therefore aimed to clarify the diagnostic reliability of testing with ghrelin, the natural GHS. We studied the GH response (every 15 min from −15 to +120 min) to acylated ghrelin (1 mg/kg iv at 0 min) in 56 patients with history of pituitary disease (38 M, 18 F; age [mean ± SD]: 52.4±18.6 yr; BMI: 26.8±5.1 kg/m2 ). As gold standard for the diagnosis of GHD we assumed the lack of GH response to GHRH+ARG. We tried to identify the best GH cut-off to ghrelin test, defined as the one with the best sensitivity and specificity, using the Receiver-Operating Characteristic Curve (R.O.C.) analysis. The best GH cut-off to ghrelin test was 3.1 mg/l in the whole population, with a sensibility and specificity value of 81.6% and 83.3%, respectively; the diagnostic accuracy was 82.1%. The best cutoff to ghrelin test in the lean, overweight and obese population was ≤3.1, ≤2.9 and ≤0.3 mg/l, respectively. The sensibility and specificity value was 83.3% and 100% in the lean subjects, 94.7% and 80% in the overweight subjects and 33.3% and 100% in the obese subjects. In conclusion, these preliminary results indicate that testing with acylated ghrelin would represent a reliable diagnostic tool for the diagnosis of adult GHD.
P10 Hypopituitarism following traumatic brain injury and subarachnoid hemorrhage: a prospective study A.D. Jonasdottir1 , H.A. Sigurjonsdottir2 . 1 Department og Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland; 2 Endocrinology and Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland Background: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are significant causes of mortality and morbidity in young people. Recent studies have shown that hypopituitarism (HP) is a common complication of TBI and SAH although the natural history of this disorder is not well described. Prospective studies have shown that HP can be chronic, transient or appear at later stages. Most patients with moderate TBI and all patients with severe TBI and SAH in Iceland are transmitted to Landspitali University Hospital (LSH). Three hundred and nineteen thousand people are living in Iceland. The aim of this study is to assess the prevalence of HP following TBI and SAH in Iceland. Subjects and methods: During a 12 month period 39 patients were prospectively included in the study at the time of admission to LSH. Twenty-two TBI patients were included, 16 with severe TBI (GCS < 9) and 6 with moderate TBI (GCS 9–12), 17 males and 5 females, mean age 37±13 years (range 18–65 years). Seventeen SAH patients were also included, 10 males and 7 females, mean age 51±11 years (range 30–66 years). Five patients were excluded for follow up, 4 patients died in the acute phase and 1 patient was not an Icelandic citizen. Ten patients declined participation in the follow up. Pituitary function was assessed 3 months after TBI/SAH. Baseline hormone levels were measured and an insulin tolerance test (ITT) was performed. If ITT was contraindicated then a Synachten test and a GHRH-Arginine test was used. Results: Pituitary function was assessed in 24 patients after 3 months, 12 TBI patients and 12 SAH patients. Hyperprolactinemia was demonstrated in one woman after severe TBI. Two patients were shown to have growth hormone deficiency, a 56 year old man after SAH and a 37 year old man who had sustained a severe TBI. In both cases the deficiency was confirmed with GHRH-Arginine test. Two of the premenopausal women had gonadal dysfunction after the incident, both had oligomenorrhoea after SAH. Conclusion: HP was confirmed in 5 patients in this study. HP was present in 2 of 12 (16.7%) and 3 of 12 (25%) patients 3 months after severe TBI and SAH respectively. This is in line with results of other published studies. This indicates the need for screening of pituitary function after SAH as well as TBI. P11 Comparison of intuitiveness, ease of use and preference in three growth hormone injection devices A.-M. Kappelgaard1 , K. Hartmann2 , T. Rohrer3 , G.S. Fuchs4 , 6 1 F. Winter5 , A. Pfutzner ¨ . Growth Hormone Scientific Marketing, Novo Nordisk A/S, Virum, Denmark; 2 Paediatric Endocrinology & Diabetology, Institute for Paediatric Endocrinology & Diabetology, Frankfurt, Germany; 3 Pediatric Clinic, Saarland University, Homburg, Germany; 4 Clinical Operations, Insulin and Devices, Novo Nordisk A/S, Soeborg, Denmark; 5 IKFE-CRO GmbH, IKFE-CRO GmbH, Mainz, Germany; 6 Institute for Clinical Research and Development, Institute for Clinical Research and Development, Mainz, Germany Aim: Recombinant growth hormone (GH) is widely used to treat short stature in growth hormone deficient (GHD) children and in other pediatric conditions. Most patients respond well to GH treatment, but as GH is injected daily, treatment adherence may be problematic. To maximize treatment adherence, a number of injection devices have been developed. In this study we compare the intuitiveness and ease of use of three GH injection devices: Norditropin® FlexPro® (Novo Nordisk A/S, Bagsværd, Denmark),
Poster Presentations / Growth Hormone & IGF Research 20 (2010) S39–S81
patients with acromegaly. Basal serum TSH, free T4 and free T3 concentrations and ultrasound findings in 60 patients with newly diagnosed acromegaly (M/F 25/35, age range: 21–86 years old) including one patient with GH/TSH producing pituitary adenoma were studied. Median serum free T3 , free T4 and TSH levels were 3.15 pg/ml (range: 1.10–5.34, normal: 2.4–4.0), 1.25 ng/dl (range: 0.89–1.78, normal: 0.94–1.60) and 0.75 mU/ml (range: <0.005–4.02, normal: 0.38–4.30), respectively. Basal serum TSH levels were lower than the lower limit of normal range without elevated freeT3 or free T4 levels in 12 of 60 (20%) patients. Anti-thyroglobulin and antimicrosomal antibodies were measured in 20 patients. Titers of these antibodies were positive in 4 patients. Thyroid ultrasonography was performed in 54 patients. Adenomatous nodules, multinodular goiter and papillary thyroid cancer were revealed in 25 (46%), 16 (30%) and 2 patients. Furthermore, there was one patient who had an episode of thyroidectomy due to a papillary thyroid cancer 6 months before the diagnosis of acromegaly. In conclusion, thyroid function was normal in most patients with acromegaly, but basal TSH decreased in 20% of the patients. One mechanism for suppressed serum TSH levels is presumably due to the activation of somatostatin release driven by GH excess. The association of thyroid cancer was observed in 5% of the patients, indicating that a screening of thyroid gland using ultrasonograpy is recommended at least once in patients with acromegaly. P9 Ghrelin test: a new tool for the diagnosis of GH deficiency in adults V. Gasco1 , F. Marotta2 , G. Beccuti2 , S. Grottoli2 , E. Ghigo2 . 1 Department of Internal Medicine, Division of Endocrinology and Metabolism., University of Turin, Turin, Italy; 2 Department of Internal Medicine, Division of Endocrinology and Metabolism, University of Turin, Turin, Italy ITT is the test of reference for the diagnosis of adult GH deficiency (GHD), but it is recognized that also GHRH in combination with arginine (ARG) or GH secretagogues (GHS) are equally reliable tests. It has also been suggested that testing with GHS would represent a potent stimulus exploring also the integrity of hypothalamic pathways controlling somatotropic function. We therefore aimed to clarify the diagnostic reliability of testing with ghrelin, the natural GHS. We studied the GH response (every 15 min from −15 to +120 min) to acylated ghrelin (1 mg/kg iv at 0 min) in 56 patients with history of pituitary disease (38 M, 18 F; age [mean ± SD]: 52.4±18.6 yr; BMI: 26.8±5.1 kg/m2 ). As gold standard for the diagnosis of GHD we assumed the lack of GH response to GHRH+ARG. We tried to identify the best GH cut-off to ghrelin test, defined as the one with the best sensitivity and specificity, using the Receiver-Operating Characteristic Curve (R.O.C.) analysis. The best GH cut-off to ghrelin test was 3.1 mg/l in the whole population, with a sensibility and specificity value of 81.6% and 83.3%, respectively; the diagnostic accuracy was 82.1%. The best cutoff to ghrelin test in the lean, overweight and obese population was ≤3.1, ≤2.9 and ≤0.3 mg/l, respectively. The sensibility and specificity value was 83.3% and 100% in the lean subjects, 94.7% and 80% in the overweight subjects and 33.3% and 100% in the obese subjects. In conclusion, these preliminary results indicate that testing with acylated ghrelin would represent a reliable diagnostic tool for the diagnosis of adult GHD.
P10 Hypopituitarism following traumatic brain injury and subarachnoid hemorrhage: a prospective study A.D. Jonasdottir1 , H.A. Sigurjonsdottir2 . 1 Department og Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland; 2 Endocrinology and Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland Background: Traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) are significant causes of mortality and morbidity in young people. Recent studies have shown that hypopituitarism (HP) is a common complication of TBI and SAH although the natural history of this disorder is not well described. Prospective studies have shown that HP can be chronic, transient or appear at later stages. Most patients with moderate TBI and all patients with severe TBI and SAH in Iceland are transmitted to Landspitali University Hospital (LSH). Three hundred and nineteen thousand people are living in Iceland. The aim of this study is to assess the prevalence of HP following TBI and SAH in Iceland. Subjects and methods: During a 12 month period 39 patients were prospectively included in the study at the time of admission to LSH. Twenty-two TBI patients were included, 16 with severe TBI (GCS < 9) and 6 with moderate TBI (GCS 9–12), 17 males and 5 females, mean age 37±13 years (range 18–65 years). Seventeen SAH patients were also included, 10 males and 7 females, mean age 51±11 years (range 30–66 years). Five patients were excluded for follow up, 4 patients died in the acute phase and 1 patient was not an Icelandic citizen. Ten patients declined participation in the follow up. Pituitary function was assessed 3 months after TBI/SAH. Baseline hormone levels were measured and an insulin tolerance test (ITT) was performed. If ITT was contraindicated then a Synachten test and a GHRH-Arginine test was used. Results: Pituitary function was assessed in 24 patients after 3 months, 12 TBI patients and 12 SAH patients. Hyperprolactinemia was demonstrated in one woman after severe TBI. Two patients were shown to have growth hormone deficiency, a 56 year old man after SAH and a 37 year old man who had sustained a severe TBI. In both cases the deficiency was confirmed with GHRH-Arginine test. Two of the premenopausal women had gonadal dysfunction after the incident, both had oligomenorrhoea after SAH. Conclusion: HP was confirmed in 5 patients in this study. HP was present in 2 of 12 (16.7%) and 3 of 12 (25%) patients 3 months after severe TBI and SAH respectively. This is in line with results of other published studies. This indicates the need for screening of pituitary function after SAH as well as TBI. P11 Comparison of intuitiveness, ease of use and preference in three growth hormone injection devices A.-M. Kappelgaard1 , K. Hartmann2 , T. Rohrer3 , G.S. Fuchs4 , 6 1 F. Winter5 , A. Pfutzner ¨ . Growth Hormone Scientific Marketing, Novo Nordisk A/S, Virum, Denmark; 2 Paediatric Endocrinology & Diabetology, Institute for Paediatric Endocrinology & Diabetology, Frankfurt, Germany; 3 Pediatric Clinic, Saarland University, Homburg, Germany; 4 Clinical Operations, Insulin and Devices, Novo Nordisk A/S, Soeborg, Denmark; 5 IKFE-CRO GmbH, IKFE-CRO GmbH, Mainz, Germany; 6 Institute for Clinical Research and Development, Institute for Clinical Research and Development, Mainz, Germany Aim: Recombinant growth hormone (GH) is widely used to treat short stature in growth hormone deficient (GHD) children and in other pediatric conditions. Most patients respond well to GH treatment, but as GH is injected daily, treatment adherence may be problematic. To maximize treatment adherence, a number of injection devices have been developed. In this study we compare the intuitiveness and ease of use of three GH injection devices: Norditropin® FlexPro® (Novo Nordisk A/S, Bagsværd, Denmark),