GH Stimulation testing is unnecessary in patients with hypothalamic–pituitary disease, preserved pituitary function, and IGF-I SDS ≥ 0

Valentina Gasco

doi:10.1007/s11102-026-01697-3

GH Stimulation testing is unnecessary in patients with hypothalamic–pituitary disease, preserved pituitary function, and IGF-I SDS ≥ 0

2026-07-23

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AI

V

Valentina Gasco *

D

Daniela Cuboni

M

Michela Sibilla

F

Francesca Mocellini

A

Alice Martinotti

D

Davide Lucisano

E

Ezio Ghigo

G

Gianluca Aimaretti

S

Silvia Grottoli

M

Mauro Maccario

DOI：10.1007/s11102-026-01697-3

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In adults with hypothalamic–pituitary disease, the presence of at least three additional pituitary hormone deficiencies, with or without markedly reduced IGF-I levels, is considered diagnostic of growth hormone deficiency (GHD) without the need for stimulation testing. In all other cases, dynamic testing is required despite its well-recognized limitations. To date, no formal strategy has been proposed to exclude GHD without performing stimulation tests. This study aims to develop a probabilistic model to estimate the likelihood of GHD in adults with hypothalamic–pituitary disease but no additional pituitary hormone deficiencies, based on IGF-I standard deviation scores (SDS). We combined literature-derived data on: (1) the probability of an impaired GH response to stimulation tests in patients with hypothalamic–pituitary disease and preserved anterior pituitary function; and (2) the probability that adults with isolated GHD present IGF-I SDS values ≥ 0, ≥ 0.5, or ≥ 1. A Bayesian approach was applied to estimate the post-test probability of GHD in patients meeting these criteria. Across all models, the estimated probability of adult-onset GHD ranged from 6.5% to 19.8%, while the probability of childhood-onset GHD ranged from 2.9% to 9.1%, consistently remaining below 20%, regardless of the IGF-I SDS cut-off applied. In adults with hypothalamic–pituitary disease but no additional hormonal deficiencies, IGF-I SDS values ≥ 0 identify a subgroup with a low, clinically acceptable probability of GHD, in whom stimulation testing may reasonably be avoided. This proof-of-concept model supports a simplified, probability-based diagnostic approach.

Keywords:

Adult growth hormone deficiency

IGF-I

Bayesian analysis

Diagnostic probability

GH stimulation testing

Pituitary function

GH Stimulation testing is unnecessary in patients with hypothalamic–pituitary disease, preserved pituitary function, and IGF-I SDS ≥ 0

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