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Somatostatin Infusion Withdrawal: Studies in Normal Children and in Children with Growth Hormone Deficiency

Divisione di Pediatria (M.C., C.B., O.P.), Ospedale Bambino Gesù, IRCCS, 00050 Roma, Italy; Dipartimento di Farmacologia, Chemioterapia e Tossicologia Medica (A.E.R., S.G.C., E.E.M.), Università di Milano, Milan 20129, Italy; and Servizio di Endocrinologia Pediatrica (P.C., S.L.), Ospedale Microcitemico, 09100 Cagliari, Italy

Address correspondence and requests for reprints to: Eugenio E. Müller, Dipartmento di Farmacologia, Universitá Degli Studi di Milano, Via Vanvitelli, 32, Milan 20129, Italy.

Withdrawal of a somatostatin infusion (SSIW) is followed by a rebound rise of GH in both animals and normal adult men, a phenomenon likely mediated by endogenous GHRH function. In the present study, we have evaluated the GH response to SSIW in a group of 28 prepubertal children (18 boys and 10 girls; aged 3.7–11.1 yr). Six children had GH deficiency [GHD; GH responses to pyridostigmine (PD)+GHRH and to clonidine <20 and <7 µg/L, respectively], 4 children had GH neurosecretory dysfunction (GHND; GH responses to PD+GHRH and to clonidine 20 and >7 µg/L, respectively; mean integrated nighttime GH concentrations <3 µg/L), and 18 children were short normal children [normal controls (NC)]. All children received a constant infusion of SS at the dose of 3 µg/Kg·h for 90 min.

SSIW elicited a clear-cut GH rise in NC children (13.7 ± 1.0 µg/L), but not in GH-deficient children, regardless of the underlying etiology (GHD, 1.6 ± 0.4 µg/L; GHND, 2.4 ± 0.3 µg/L). The GH response to SSIW was similar between GHD and GHND children. There was no overlapping of the maximum SSIW-stimulated GH peaks between NC and GHD or GHND children.

In conclusion, we have demonstrated that SSIW elicits a significant GH rise in NC children, but not in GH-deficient children, regardless of the underlying etiology (GHD or GHND). This resulted in complete discrimination of NC from GHD or GHND children. Were these present findings confirmed on a larger number of children, SSIW, because of its testing efficaciousness and safety, procedural simplicity, and economy holds promise of being a useful diagnostic tool for GH-dependent growth disorders.

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