GHRH-arginine Test To Confirm Isolated GHD after SAH

  • Research type

    Research Study

  • Full title

    The Incidence of Growth Hormone Deficiency Post Subarachnoid Haemorrhage When Using Growth Hormone Releasing Hormone (GHRH)-Arginine Stimulation Test To Confirm Isolated Growth Hormone Deficiency

  • IRAS ID

    197826

  • Contact name

    Sumithra Giritharan

  • Contact email

    sumithra.giritharan@srft.nhs.uk

  • Sponsor organisation

    Salford Royal NHS Foundation Trust

  • Duration of Study in the UK

    0 years, 8 months, 22 days

  • Research summary

    In an on-going study at our centre assessing Growth Hormone Replacement (GHR) in survivors of subarachnoid haemorrhage (SAH) (REC ref: 14/NW/0191), we have found that patients who were detected to have growth hormone deficiency had a higher weight, BMI and waist hip ratio as compared to patients with normal growth hormone levels. In this study we have incorporated the use of a Glucagon Stimulation Test (GST) to screen for GHD and a second Arginine Stimulation Test (AST) to confirm this in patients with isolated GHD. However the GST has been shown to wrongly diagnose GHD in up to 45% overweight adults with no known pituitary disease. It has been previously demonstrated that the AST can overestimate GHD in up to 59% of healthy controls. As such, there is concern that we may be over-diagnosing GHD with these tests. The Growth Hormone Releasing Hormone (GHRH)-arginine stimulation test is recognised as an excellent test of GH, and has the further advantage of having BMI specific cut-offs, eliminating the effect of BMI on GH response. The GHRH-arginine stimulation test was used in clinical practice several years ago, however due to manufacturing difficulties of GHRH, the price of this has increased tremendously and as such it is no longer used in clinical practice. We therefore propose to re-assess all patients who have been previously diagnosed with isolated GHD post SAH with GST and AST with GHRH-arginine stimulation test. We feel it is imperative to use a robust test of GH axis to be able to determine the true incidence of isolated GHD post SAH, to avoid wrongly treating patients with Growth Hormone Replacement (GHR) and the costs associated with this (lifelong).

  • REC name

    North West - Greater Manchester East Research Ethics Committee

  • REC reference

    16/NW/0115

  • Date of REC Opinion

    25 Feb 2016

  • REC opinion

    Favourable Opinion