Sex steroid priming on growth hormone stimulation test: a scoping review

Background/Objectives: Growth hormone (GH) secretion and activity are closely modulated by sex steroids, particularly during puberty, when GH response to stimulation tests (GHSTs) may be blunted in children with low circulating sex steroids. This systematic review evaluates the role of sex steroid priming in enhancing GH secretion during GHST and improving diagnostic accuracy especially in peripubertal children with GH deficiency (GHD). Methods: We conducted a medical literature review to assess the use of sex steroid priming in children undergoing GHST; our search was carried out via PubMed after paper selection based on strict eligibility criteria. Results: Seventeen studies published between 1969 and 2022 were analyzed overall, which corresponded to a total number of 1097 participants. Most studies reported a significant increase in GH peak levels after priming, reducing false-positive GHD diagnoses. However, protocols varied considerably in hormone type, dosage, and administration, and some studies showed no benefit in the case of a true GHD. Conclusions: While sex steroid priming appears to improve GHST specificity in GHD without negatively impacting growth outcomes, standardized guidelines about pre-administration of exogenous sex steroids are currently lacking, and further prospective studies are needed to define its diagnostic potential.