Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 5:16:1571685.
doi: 10.3389/fendo.2025.1571685. eCollection 2025.

Back to normal? A retrospective study on stimulation test and endocrinological diagnosis before, during and after COVID-19 pandemics

Martina Peinkhofer #  1 , Sofia Passarella #  1 , Paolo Dalena  1   2 , Gianluca Tamaro  2 , Viviana Vidonis  2 , Giada Vittori  2 , Daniela Slama  2 , Elena Faleschini  2 , Egidio Barbi  1   2 , Gianluca Tornese  1   2
Affiliations

Back to normal? A retrospective study on stimulation test and endocrinological diagnosis before, during and after COVID-19 pandemics

Martina Peinkhofer et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: The COVID-19 pandemic disrupted healthcare systems, affecting consultations and diagnostics. In pediatric endocrinology, referral patterns shifted, with increased central precocious puberty (CPP) diagnoses and decreased growth hormone deficiency (GHD) evaluations. This study examines trends in stimulation tests, referrals, and diagnoses from 2019 to 2023 to assess the pandemic's impact on pediatric endocrinology.

Methods: This retrospective study analyzed stimulation tests performed at the Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste, Italy, from 2019 to 2023, divided into pre-pandemic (2019-March 2020), pandemic (March 2020-January 2022), and post-pandemic (February 2022-December 2023) phases.

Results: A total of 1,526 tests were conducted on 1,042 patients. Tests per day remained stable (pre-pandemic: 0.84; pandemic: 0.82; post-pandemic: 0.85). The Arginine Stimulation Test (ATT), the most frequent test pre-pandemic (31%), decreased during the pandemic (20%, p<0.001), while the LHRH Test (LHRHT) increased from 22% to 28% (p<0.001), becoming the most requested test. Diagnosis rates for GHD and CPP remained stable, but the proportion of females diagnosed with CPP increased significantly during the pandemic (91% vs. 69%, p=0.022). CPP testing declined (p=0.018) post-pandemic, while GHD testing returned to pre-pandemic levels.

Conclusion: The pandemic altered diagnostic patterns, with reduced GHD evaluations reflecting limited healthcare access. Post-pandemic recovery suggests a resolution of diagnostic delays. The temporary surge in CPP cases, likely influenced by pandemic-related lifestyle changes, subsided post-pandemic, aligning with pre-pandemic trends. To date, no other studies have reported similar variations in GHD incidence during the pandemic.

Keywords: COVID-19; central precocious puberty (CPP); growth hormone deficiency; precocious puberty; stimulation tests.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Distribution of the principal stimulation tests (number of tests per day) across the three time periods (pre-pandemic, pandemic, and post-pandemic). The tests included: Arginine Tolerance Test (ATT) (white bars), Insulin Tolerance Test (ITT) (light gray bars), Luteinizing Hormone-Releasing Hormone Test (LHRHT) (medium gray bars), and Standard Dose Synacthen Test (SDST) (dark gray bars). Asterisks (*) indicate statistically significant differences (p < 0.05) between groups.
Figure 2
Figure 2
Trends in stimulation tests and diagnoses for central precocious puberty (CPP) and growth hormone deficiency (GHD) across the three study periods (pre-pandemic, pandemic, and post-pandemic). Solid lines represent the number of stimulation tests per day, with gray indicating CPP and black indicating GHD. Dashed lines represent the number of diagnoses per day, with gray for CPP and black for GHD. Asterisks (*) indicate statistically significant differences (p < 0.05) between time periods.
See this image and copyright information in PMC

References

    1. Indolfi G, Stivala M, Lenge M, Diaz Naderi R, McIntosh J, Llandrich RC, et al. Impact of SARS-CoV-2 pandemic and strategies for resumption of activities during the second wave of the pandemic: A report from eight paediatric hospitals from the ECHO network. Front Public Health. (2021) 9:630168. doi: 10.3389/fpubh.2021.630168 - DOI - PMC - PubMed
    1. Cozzi G, Molina Ruiz I, Giudici F, Romano S, Grigoletto V, Barbi E, et al. Pediatric emergency cases in the first year of the COVID-19 pandemic in a tertiary-level emergency setting. Front Pediatr. (2022) 10:918286. doi: 10.3389/fped.2022.918286 - DOI - PMC - PubMed
    1. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. (2020) 4:e10–1. doi: 10.1016/S2352-4642(20)30108-5 - DOI - PMC - PubMed
    1. Barten DG, Latten GHP, Van Osch FHM. Reduced emergency department utilization during the early phase of the COVID-19 pandemic: viral fear or lockdown effect? Disaster Med Public Health Prep. (2022) 16:36–9. doi: 10.1017/dmp.2020.303 - DOI - PMC - PubMed
    1. Bellotto E, Monasta L, Pellegrin MC, Bossini B, Tamaro G, Conte MS, et al. Pattern and features of pediatric endocrinology referrals: A retrospective study in a single tertiary center in Italy. Front Pediatr. (2020) 8:580588. doi: 10.3389/fped.2020.580588 - DOI - PMC - PubMed

LinkOut - more resources