Overdiagnosis of short, overweight kids.

On January 1, 2010, in Uncategorized, by Andrea

Kids that are both overweight AND short might be misdiagnosed when it comes to growth hormone deficiency.  Which is great — cause we want to screw up our kids even more, yes?

From Medscape:

Growth Hormone Deficiency May Be Overdiagnosed in Short Children With High BMI

NEW YORK (Reuters Health) Dec 30 – Body mass index (BMI) negatively affects peak stimulated growth hormone (GH) in children with short stature, which makes children with higher BMI standard deviation (SD) scores more vulnerable to overdiagnosis of GH deficiency, according to researchers from the Massachusetts General Hospital in Boston.

Led by Dr. Takara L. Stanley, they point out that while BMI is known to be inversely related to spontaneous GH secretion in children, there was little information on the impact of BMI on stimulated GH in younger patients.

In the December issue of the Journal of Clinical Endocrinology & Metabolism, the researchers report on the results of GH stimulation testing in 116 normal-weight children and adolescents (mean age, 10.3 years) with short stature.

BMI SD score was significantly and inversely associated with peak stimulated GH levels, regardless of whether SD score was based on bone age or chronological age, the authors report.

In contrast, height SD score was not significantly associated with peak GH levels.

In multivariate analyses, higher BMI was consistently and independently associated with lower peak growth hormone levels.

Ultimately, 36 children (31%) had a peak GH below 10 mcg/L, which is usually taken to indicate GH deficiency in the pediatric age group.

The authors found, however, that with this cutoff, GH deficiency would be diagnosed in 70% of children with a BMI SD score greater than 1, in 38% of those with a BMI SD score between 0 and 1, in 18% of children with a BMI SD score from 0 to -1, and in 29% with a BMI SD score less than -1.

Similar patterns were seen with cutoffs of 7 and 5 mcg/L.

“Our data highlight the need to consider BMI when interpreting the results of provocative GH stimulation testing in children,” the investigators say.

They conclude, “Although larger studies are clearly needed to determine the causative factors and metabolic consequences of reduced GH with increasing adiposity in the pediatric age group, our data demonstrate that even in a normal-weight cohort, children with higher BMI are disproportionately overdiagnosed with GH deficiency.”

J Clin Endocrinol Metab 2009;94:4875-4881.

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