Pituitary abnormalities, peak GH levels similar between boys and girls with GH deficiency
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Key takeaways:
- GH deficiency is diagnosed more often among boys than girls.
- A similar proportion of boys and girls have multiple pituitary hormone deficiencies.
- No sex-based differences for pituitary abnormalities were found.
The percentage of children with growth hormone deficiency and pituitary abnormalities or multiple pituitary hormone deficiencies was similar between boys and girls, according to study findings.
“This is the first attempt in pediatrics to demonstrate the true incidence of GH deficiency in boys and girls by limiting the male sex bias for GH deficiency evaluation and testing,” Rohan K. Henry, MD, MS, associate professor of pediatrics at the Ohio State University College of Medicine, told Healio. “In addition to showing that GH deficiency occurs in a similar percentage in boys and girls when it is classified as existing in the context of multiple hormonal deficiencies, we demonstrated that in our cohort, there was also a similar incidence of pituitary imaging abnormalities and even pituitary tumors. These findings highlight the need to acquire pituitary imaging in both males and females diagnosed with GH deficiency in the context of a short stature evaluation.”
Henry and colleagues conducted a retrospective study with children aged 3 to 16 years who were referred to endocrinology clinics for short stature from 2012 to 2019. GH provocative testing was performed for children with suspected GH deficiency based on clinical history and anthropometric data. Sex, MRI results, height z scores and other concurrent disorders were collected from medical records. Peak GH was defined as the highest detected GH level during testing. Participants were stratified into three groups based on peak GH: less than 5 ng/mL, 5 ng/mL to 7.4 ng/mL and 7.5 ng/mL to 9.9 ng/mL Pituitary abnormalities were identified through MRI.
Of 5,880 children referred for short stature, 20% of boys and 15.3% of girls underwent GH provocative testing. There were 292 boys and 107 girls diagnosed with GH deficiency following testing.
A similar proportion of boys and girls were allocated to each peak GH group. Of those diagnosed with isolated GH deficiency, 75% were boys and 25% were girls (P < .001). There was no significant difference in the percentage of boys and girls with multiple pituitary hormone deficiencies. Henry said the findings for isolated GH deficiency may indicate a trend to overdiagnose boys or underdiagnose girls.
“Though initially we postulated that there would not be a sex difference in certain GH deficiency classifications based on biological implausibility, we were surprised this was so, given the male predominance in GH-deficient cases based on peak GH levels,” Henry said. “However, when closely examined, this likely reflects inherent weaknesses and a lack of discrimination of provocation testing in determining who has GH deficiency vs. non-growth hormone-deficient cases of short stature.”
The percentage of boys and girls with pituitary abnormalities was similar. There was no relationship between sex and MRI findings in the study.
Prospective multicenter studies using different diagnostic criteria for GH deficiency are needed to confirm the study’s findings, Henry said.
For more information:
Rohan K. Henry, MD, MS, can be reached at rohan.henry@nationwidechildrens.org.
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