Increased growth hormone response to apomorphine in Parkinson disease compared with multiple system atrophy

Background: Parkinson disease (PD) is often difficult to distinguish from parkinsonian syndromes of other causes in early stages of the disease. In search of a suitable endocrinologic challenge test, we investigated dopaminergic sensitivity in patients with de novo parkinsonian syndromes. Objective: We measured the growth hormone (GH) response to a subthreshold dose of the dopamine l-dopamine 2 receptor agonist apomorphine hydrochloride to differentiate parkinsonian syndromes from PD. Patients and Methods: Seventeen patients with a clinical diagnosis of PD, 16 patients with a clinical diagnosis of multiple system atrophy, and 11 healthy controls. The GH response to a subthreshold dosage of apomorphine and to somatorelin (GH-releasing factor) was tested in a randomized order; on the third day the protocol was repeated with a clinically effective dose of apomorphine. Results: The GH response to the low dose of apomorphine was significantly increased in patients with PD when compared with patients with multiple system atrophy or the control subjects (multivariate analyses of covariance; univariate F test, all P < .05). In contrast, there were no significant group differences with use of the higher dose of apomorphine or in the somatorelin-induced GH release Conclusions: The GH response to a subthreshold dose of apomorphine appears to be a useful tool to identify patients with PD vs multiple system atrophy. The enhanced GH response to a subthreshold dopaminergic stimulus may reflect a hypersensitivity of the extrastriatal dopamine receptors in PD.