Diagnostic efficiency of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: importance of an appropriate reference population

Granada, ML; Murillo, Jorge; Lucas, Anna; Salinas, Isabel; Llopis, María Antonia; Castells, Ignasi; M, Foz; Sanmartı́, Anna

doi:10.1530/eje.0.1420243

Cited by 49 publications

(43 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings have been confirmed by others who also proposed an IGF1 cut-off limit of around K2 S.D. All agree that the diagnostic reliability of low IGF1 levels is satisfactory when patients with CO severe GHD or multiple pituitary deficits are considered, particularly below 40 years of age (2,4,(11)(12)(13)(14)(15). These patients therefore do not require a GH stimulation test to make the diagnosis of adult GHD; however, it remains that patients suspected for GHD showing normal IGF1 levels must undergo provocative tests (2,4).…”

Section: How To Testsupporting

confidence: 66%

Retesting the childhood-onset GH-deficient patient

Gasco¹,

Corneli

Beccuti³

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

GH deficiency (GHD) in adults has to be shown by a single provocative test, provided that it is validated. Insulin tolerance test (ITT) has been indicated as the test of choice; now also glucagon test is validated and represents an alternative. The GHRH plus arginine (ARG) test and testing with GHRH plus a GH secretagogue are equally reliable diagnostic tools, and are now considered as 'golden' standards as ITT. Childhood-onset (CO) GHD needs retesting in late adolescence or young adulthood; this is a major clinical challenge and raises questions about the most appropriate method and cut-off value. Appropriate re-evaluation of GH status is represented by simple measurement of IGF1 concentration off rhGH treatment. Clearly, low IGF1 levels are evidence of persistent severe GHD in subjects with genetic GHD or panhypopituitarism. However, normal IGF1 levels never rule out severe GHD and CO-GHD with normal IGF1 levels must undergo a provocative test. The appropriate GH cut-off limit is specific for each provocative test. As shown by the ROC curve analysis, in late adolescents and young adults, the lowest normal GH peak response to ITT is 6.1 mg/l while that to GHRHCARG test is 19.0 mg/l. These cut-off limits, however, are just indicative as being variable as a function of the assay used. No other test is validated for retesting. As GHRHCARG test mostly explores the GH-releasable pool, normal GH response would be verified by a second ITT in order to rule out subtle hypothalamic defect. European Journal of Endocrinology 159 S45-S52

show abstract

Section: How To Testsupporting

confidence: 66%

Retesting the childhood-onset GH-deficient patient

Gasco¹,

Corneli

Beccuti³

et al. 2008

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…The relationship between body weight and IGF-I has been discussed previously [26]. However, no simple or age-adjusted correlation was found between IGF-I and weight among the present participants.…”

Section: Discussioncontrasting

confidence: 47%

“…The patients with pituitary deficiency had lower standard deviation (SD) scores for IGF-I and the more deficiencies they had, the lower the SD score [26]. This study, in a Spanish reference population, also compared IGFBP-3 and urinary GH samples, and concluded that a combination of two methods increased the specificity to 100% in diagnosing GHD [26].…”

Section: Discussionmentioning

confidence: 99%

Insulin-Like Growth Factor I Levels in Healthy Adults

et al. 2004

View full text Add to dashboard Cite

Insulin-like growth factor I (IGF-I) levels mainly reflect secretion of growth hormone (GH) in the body. The aims of this study were to compare different IGF-I assay methods in healthy individuals, test the reliability of the methods and discuss the utility of IGF-I measurement in adults. The Nichols Institute Diagnostics radioimmunoassay was used to evaluate IGF-I in two random population samples of men and women (aged 25–64 years, n = 392) taken 10 years apart, in 1985 and 1995. This method for IGF-I testing was also compared with an immunoradiometric assay (IRMA) method in 387 men and women participating in the World Health Organization MONICA (MONItoring of trends and determinants for CArdiovascular diseases) Project, Göteborg, Sweden, in 1995. Serum IGF-I decreased with increasing age in both men and women. IGF-I was higher in young women compared with young men in both cohorts, while the opposite was found in the highest age group. Age-adjusted significant correlations were found between IGF-I and smoking, fibrinogen, coffee consumption, lipoprotein (a), osteocalcin and IGF-binding protein 3. The two cohorts showed similar mean IGF-I concentrations irrespective of method. The correlation between the Nichols and the IRMA methods was high: r = 0.93 (p < 0.0001). Based on this and previous studies, population-based IGF-I measurements are robust irrespective of which commercially available method of assay is used. IGF-I levels can be used in diagnosing acromegaly as well as providing target values. IGF-I assay can be used as a complement to stimulation testing in the diagnosis of GH deficiency, and as a tool for GH dose titration.

show abstract

“…However, the reliability of serum IGF-1 as an indicator of GH deficiency is being debated (Aimaretti et al, 1998(Aimaretti et al, , 2003Granada et al, 2000). Specifically, the consensus guidelines for the diagnosis and treatment of adults with GH deficiency conclude that, ''a normal IGF-1 does not rule out GH deficiency'' (Ho, 2007).…”

Section: Kasturi and Steinmentioning

confidence: 99%

Traumatic Brain Injury Causes Long-Term Reduction in Serum Growth Hormone and Persistent Astrocytosis in the Cortico-Hypothalamo-Pituitary Axis of Adult Male Rats

Kasturi

Stein

2009

Journal of Neurotrauma

View full text Add to dashboard Cite

In humans, traumatic brain injury (TBI) causes pathological changes in the hypothalamus (HT) and the pituitary. One consequence of TBI is hypopituitarism, with deficiency of single or multiple hormones of the anterior pituitary (AP), including growth hormone (GH). At present no animal model of TBI with ensuing hypopituitarism has been demonstrated. The main objective of this study was to investigate whether cortical contusion injury (CCI) could induce long-term reduction of serum GH in rats. We also tested the hypothesis that TBI to the medial frontal cortex (MFC) would induce inflammatory changes in the HT and AP. Methods: Nine young adult male rats were given sham surgery (n ¼ 4) or controlled impact contusions (n ¼ 5) of the MFC. Two months postinjury they were killed, trunk blood collected and their brains and AP harvested. GH was measured in serum and AP using ELISA and Western blot respectively. Interleukin-1b (IL-1b) and glial fibrillary acidic protein (GFAP) were measured in the cortex (Cx), HT, and AP by Western blot. Results: Lesion rats had significantly (p < 0.05) lower levels of GH in the AP and serum, unaltered serum IGF-1, and significantly (p < 0.05) higher levels of IL-1b in the Cx and HT and GFAP in the Cx, HT, and AP compared to that of shams. Conclusion: CCI leads to a long-term depletion of serum GH in male rats. This chronic change in GH post-TBI is probably the result of systemic and persistent inflammatory changes observed at the level of HT and AP, the mechanism of which is not yet known.

show abstract

Diagnostic efficiency of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: importance of an appropriate reference population

Cited by 49 publications

References 47 publications

Retesting the childhood-onset GH-deficient patient

Retesting the childhood-onset GH-deficient patient

Insulin-Like Growth Factor I Levels in Healthy Adults

Traumatic Brain Injury Causes Long-Term Reduction in Serum Growth Hormone and Persistent Astrocytosis in the Cortico-Hypothalamo-Pituitary Axis of Adult Male Rats

Contact Info

Product

Resources

About