Limited usefulness of the test of spontaneous growth hormone (GH) nocturnal secretion as a screening procedure in diagnosing GH deficiency in children with short stature
Joanna Smyczyńska 1, Renata Stawerska 1, Andrzej Lewiński 2, Maciej Hilczer 3 1 - Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland 2 - Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland; Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland 3 - Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, Poland; Department of Pediatric Endocrinology, Medical University of Lodz, Lodz, Poland Ann Agric Environ Med 2014; 21 (4): ICID: 1129954 Article type: Original article
introduction and objective. In Poland, the assessment of nocturnal GH secretion has gained the status of screening test; however, this procedure is not included in international recommendations. The aim of the study was to assess the accuracy and predictive value of the test of nocturnal GH secretion as a screening procedure in diagnosing GHD, and to check the adequacy of the cut-off value for GH peak in this test on the level of 10 ng/ml. materials and methods. The analysis comprised the data of 1,000 children with short stature. In all the patients, GH secretion was assessed in a screening test (after falling asleep) and in 2 stimulating tests (reference tests), with simultaneous assessment of IGF-I secretion before stimulating tests. The indices of screening test accuracy, likelihood ratios and predictive values were assessed. The cut-off level of GH peak after falling asleep, ensuring its 95% sensitivity, was calculated in ROC curve analysis. results. Sensitivity of the screening test was 70.4%, while the specificity – 61.2%, positive likelihood ratio – 1.842, negative likelihood ratio – 0.482, positive predictive value – 0.462, negative predictive value – 0.812. The sensitivity of the test of GH secretion after falling asleep is too low with respect to the requirements for screening test. The ROC curve analysis showed 95% sensitivity for the screening test on the level of 19.0 ng/ml; however, with a very low specificity – below 25%, thus making this test completely useless as a screening procedure. conclusions. The obtained results strongly contradict the opinion that the assessment of GH secretion after falling asleep should be a screening test in diagnosing GHD in children with short stature.
DOI: 10.5604/12321966.1129954 PMID 25528941 - click here to show this article in PubMed