Abstract
Objective: The ITT is the gold-standard for assessment of GH and ACTH reserve but has certain contraindications. GH and cortisol responses of 95% sensitivity and 72% specificity for cortisol sufficiency. Using both upper and lower cut-off, 25/49 (51%) of subjects could not be diagnosed by GST alone and required further testing. Regarding GHD, 21/49 cases were classified as insufficient by ITT. ROC analysis revealed a cut-off of 2.5ng/ml with 95% sensitivity and 79% specificity. 7/49 (14%) cases were discordant in terms of defining GHD when comparing GST and ITT results, with 6 subjects being treated for GHD according to GST although being sufficient in ITT. Further analysis revealed, that the GST could be limited to 3h sampling period without any loss in accuracy. Conclusion: In our prospective series of patients with pituitary disease, GST is a potential alternative test for assessment of GH reserve, but poor for ACTH reserve, as demonstrated by comparison with the ITT. Test-specific cut-offs should be applied to avoid misinterpretation.
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