The use of Oral Bovril as growth hormone stimulation test
Introduction: The gold standard for diagnosing growth hormone deficiency is insulin tolerance test. However, this is contraindicated in patients at risk of seizure attacks. GHRH-arginine test is not widely available. The other tests have their own limitations. Oral Bovril contains arginine and ca...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Malaysian Endocrine & Metabolic Society
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/48182/ http://irep.iium.edu.my/48182/ http://irep.iium.edu.my/48182/6/PP-040.pdf |
| Summary: | Introduction: The gold standard for diagnosing growth hormone deficiency
is insulin tolerance test. However, this is contraindicated in patients at risk of
seizure attacks. GHRH-arginine test is not widely available. The other tests
have their own limitations. Oral Bovril contains arginine and can be used as
a substitute when all others are not available.
Case: A 16-year old boy with underlying mitochondrial disease,
complicated with myoclonus and secondary hypogonadism, presented
with short stature. Oral Bovril test was performed to rule out growth
hormone deficiency as other tests were not available.
Materials and Methods: Oral Bovril, given as 14g/m2 body surface area,
was used in this patient (subject A) after an overnight fast. The test was
also performed on a healthy sex-matched adult (subject B) and a sex and
age-matched patient with confirmed growth hormone deficiency (subject
C). Serial blood tests were taken at baseline and half hourly for 2.5 hours.
Results: Subject A attained peak growth hormone of 28.4mIU/L which
was consistent with a normal response, hence ruling out growth hormone
deficiency. Subject B attained peak growth hormone of 42.0mIU/L. Subject
C has suppressed growth hormone throughout the test, consistent with
previous insulin tolerance test.
Conclusion: Oral Bovril test is an option when all other growth hormone
stimulation tests cannot be performed. It is cheap, readily available, has
no side effects, does not require intravenous infusion, and has fairly good
performance. |
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