Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how

Cristina Partenope, Elena Galazzi, Assunta Albanese, Simonetta Bellone, Ivana Rabbone, Luca Persani

Research output: Contribution to journalReview articlepeer-review

Abstract

Despite decades of experience, the diagnosis of growth hormone deficiency (GHD) remains challenging, especially in peripubertal children. Failure to respond to GH stimulation tests (GHSTs) is needed to confirm GHD, but long-standing controversies regarding the number of tests needed and the interpretation of GH peaks are still a matter of debate worldwide. Diagnostic workup is even more problematic in short children with slow growth and delayed sexual development: they often exhibit low GH peaks under GHST, which often normalize as puberty progresses. Consequently, this transient suboptimal response to GHST may result in GH overtreatment, carrying both health and economic concerns. Considering the complex and bound link between GH axis and sex steroids, the use of sex steroid priming prior to GHST might be helpful in peripubertal setting. However, its use is still controversial. There is no consensus regarding patient selection, timing, dose, and preparation of sex steroids. In this review, we aim to overview the use of sex steroid priming in clinical practice, highlighting the need to develop appropriate guidelines in order to overcome diagnostic pitfalls in peripubertal age.

Original languageEnglish
Article number1072271
JournalFrontiers in Endocrinology
Volume13
DOIs
Publication statusPublished - 29 Nov 2022

Keywords

  • GH deficiency (GHD)
  • growth hormone stimulation test (GHST)
  • peripubertal age
  • pubertal delay
  • sex steroid priming
  • short stature

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