PDF(Pubmed)
Abstract：
OBJECTIVE: The clinical features of adult GH deficiency (GHD) are nonspecific, and its diagnosis is established through GH stimulation testing, which is often complex, expensive, time-consuming and may be associated with adverse side effects. Moreover, diagnosing adult GHD can be challenging due to the influence of age, gender, and body mass index on GH peak at each test. The insulin tolerance test (ITT), GHRH + arginine test, glucagon stimulation test (GST), and, more recently, testing with macimorelin are all recognized as useful in diagnosing adult GHD. To date GST is still little used, but due to the unavailability of the GHRH all over the world and the high cost of macimorelin, in the next future it will probably become the most widely used test when ITT is contraindicated. The aim of the present review is to describe the current knowledge on GST.
METHODS: Narrative review.
RESULTS: In the last years several studies have suggested some changes in the original GST protocol and have questioned its diagnostic accuracy when the classic GH cut-point of 3 μg/L is used, suggesting to use a lower GH cut-point to improve its sensitivity and specificity in overweight/obese patients and in those with lower pretest GHD probability.
CONCLUSIONS: This document provides an update on the utility of GST, summarizes how to perform the test, shows which cut-points should be used in interpreting the results, and discusses its drawbacks and caveats referring to the most recent studies.
METHODS: Narrative review.
RESULTS: In the last years several studies have suggested some changes in the original GST protocol and have questioned its diagnostic accuracy when the classic GH cut-point of 3 μg/L is used, suggesting to use a lower GH cut-point to improve its sensitivity and specificity in overweight/obese patients and in those with lower pretest GHD probability.
CONCLUSIONS: This document provides an update on the utility of GST, summarizes how to perform the test, shows which cut-points should be used in interpreting the results, and discusses its drawbacks and caveats referring to the most recent studies.
摘要：
目的：成人GH缺乏症（GHD）的临床特征是非特异性的，它的诊断是通过GH刺激测试确定的，这通常很复杂，贵,耗时，可能与不良副作用有关。此外，由于年龄的影响，诊断成人GHD可能具有挑战性，性别,以及每次测试时GH峰上的体重指数。胰岛素耐量试验(ITT),GHRH+精氨酸试验,胰高血糖素刺激试验(GST),and,最近,使用马西莫瑞林进行的检测都被认为对诊断成人GHD有用.到目前为止，商品及服务税仍然很少使用，但是由于全球无法获得GHRH以及Macimorelin的高成本，在接下来的将来，当ITT禁忌时，它可能会成为最广泛使用的测试。本综述的目的是描述当前有关商品及服务税的知识。
方法：叙事回顾。
结果：在过去几年中，一些研究提出了原始GST方案的一些变化，并且在使用3μg/L的经典GH切点时质疑其诊断准确性，建议在超重/肥胖患者和预测试GHD概率较低的患者中使用较低的GH切点来提高其敏感性和特异性。
结论：本文档提供了有关商品及服务税实用程序的更新，总结了如何执行测试，显示哪些切点应用于解释结果，并参考最新研究讨论了其缺点和警告。
方法：叙事回顾。
结果：在过去几年中，一些研究提出了原始GST方案的一些变化，并且在使用3μg/L的经典GH切点时质疑其诊断准确性，建议在超重/肥胖患者和预测试GHD概率较低的患者中使用较低的GH切点来提高其敏感性和特异性。
结论：本文档提供了有关商品及服务税实用程序的更新，总结了如何执行测试，显示哪些切点应用于解释结果，并参考最新研究讨论了其缺点和警告。
