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Donbaloğlu Z, Singin B, Acar S, Bedel A, Barsal Çetiner E, Aydın Behram B, Parlak M, Tuhan H. Evaluation of the growth response of children with growth hormone deficiency according to the peak growth hormone levels in provocation tests. Arch Pediatr 2023; 30:573-579. [PMID: 37802668 DOI: 10.1016/j.arcped.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND We aimed to evaluate the relation between the peak growth hormone (GH) levels in provocation tests and response to recombinant human GH (rhGH) therapy in patients with GH deficiency (GHD). METHODS This was a cross-sectional, single-center, and retrospective study. A total of 135 patients under the age of 16 years who were diagnosed with GHD through insulin tolerance tests and L-DOPA stimulation tests and who received rhGH therapy for at least 2 years in the Pediatric Endocrinology Clinic of Akdeniz University Hospital between 1997 and 2021 were included in the study. RESULTS The patients were divided into two groups: idiopathic GHD (group I, n = 119) and multiple pituitary hormone deficiencies or organic pathology on magnetic resonance imaging (group II, n = 16). The patients in group I were classified into three subgroups according to the peak GH values in the provocation tests (group Ia: peak GH <3 μg/L, n = 34; group Ib: peak GH between 3 and 7 μg/L, n = 71; group Ic: peak GH between 7 and 10 μg/L, n = 34). The median age was 11.5 years in group I (8.8 in group Ia, 12.1 in group Ib, 12.3 in group Ib) and 8.8 years in group II. The height standard deviation score (SDS) was -2.93 in group I (-2.85 in group Ia, -2.99 in group Ib, -2.94 in group Ic) and -3.79 in group II. The median Δheight SDS was 0.61 in group I and 1.05 in group II at the end of the first year of treatment and 0.31 in group I and 0.45 in group II at the end of the second year (p = 0.005 and p = 0.074, respectively). When the subgroups of group I were compared, height SDS, Δheight SDS, and height velocity (HV) SDS were all higher in group Ia at the end of the first year of rhGH therapy (p = 0.040, p = 0.029, and p = 0.005, respectively). The height SDS was still significantly higher in group Ia (p = 0.033) while the HV SDS and Δheight SDS were similar between the groups at the end of the second year of therapy (p = 0.164 and p = 0.522, respectively). There was a statistically significant association between the first-year HV SDS and the peak GH value in provocation tests in multiple regression analyses (p<0.001). In addition, the final model revealed that height SDS and weight SDS at the start of the treatment and the first-year HV SDS are the factors with a statistically significant effect on the second-year HV SDS (p = 0.022, p = 0.001, and p<0.001, respectively). CONCLUSION Our findings show that the lower the GH peak in provocation tests, the better the response to treatment. The best HV was observed in the first year of rhGH therapy, and the diagnosis should be checked in those patients who had a low first-year HV and did not have a severely low GH peak in provocation tests.
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Affiliation(s)
- Zeynep Donbaloğlu
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Berna Singin
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Sezer Acar
- Department of Pediatric Endocrinology, Manisa City Hospital, Manisa, Turkey
| | - Aynur Bedel
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Ebru Barsal Çetiner
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Bilge Aydın Behram
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey
| | - Hale Tuhan
- Department of Pediatric Endocrinology, Akdeniz University Hospital, Antalya, Turkey.
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Inoue-Lima TH, Vasques GA, Nakaguma M, Brito LP, Mendonça BB, Arnhold IJP, Jorge AAL. A Bayesian Approach to Diagnose Growth Hormone Deficiency in Children: Insulin-Like Growth Factor Type 1 Is Valuable for Screening and IGF-Binding Protein Type 3 for Confirmation. Horm Res Paediatr 2021; 93:197-205. [PMID: 32799208 DOI: 10.1159/000509840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The utility of insulin-like growth factor type 1 (IGF-1) is well established in the diagnosis of growth hormone deficiency (GHD), whereas IGF-binding protein type 3 (IGFBP-3) has a more controversial role. Most studies evaluated the value of these peptides by assessing their sensitivity and specificity but not considering the low prevalence of GHD among short children (<2%). OBJECTIVE To evaluate the utility of basal IGF-1 and IGFBP-3 values in the GHD diagnosis process with a Bayesian approach, based on pre- and post-test probability. METHODS We determined ROC curves, sensitivity, specificity, and positive and negative predictive values for IGF-1 and IGFBP-3 obtained from patients with GHD (n = 48) and GH-sufficient children (n = 175). The data were also analyzed by classifying the children into early childhood and late childhood (girls and boys younger and older than 8 and 9 years, respectively). RESULTS The area under the curve (AUC) of the receiver operating characteristic curve of IGF-1-SDS (standard deviation score) was greater than that of IGFBP-3-SDS (AUC 0.886 and 0.786, respectively, p = 0.001). In early childhood, the AUC of IGFBP-3-SDS was significantly improved (0.866) and similar to IGF-1-SDS (0.898). IGF-1-SDS, in comparison to IGFBP-3-SDS, had a greater sensitivity (92 vs. 45.8%, respectively), lower specificity (69 vs. 93.8%, respectively), and lower positive predictive value (5.7 vs. 13.1%, respectively), with similar negative predictive values. CONCLUSION IGF-1-SDS is a useful screening tool in the diagnosis of GHD. Although IGFBP-3-SDS lacks sensitivity, its high specificity supports the role to confirm GHD in short children, especially in early childhood. This strategy could simplify and reduce the necessity of a second laborious and expensive GH stimulation test to confirm the diagnosis of GHD.
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Affiliation(s)
- Thais H Inoue-Lima
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Gabriela A Vasques
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil.,Unidade de Endocrinologia Genetica (LIM/25), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Marilena Nakaguma
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Luciana Pinto Brito
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Berenice B Mendonça
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Ivo J P Arnhold
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Alexander A L Jorge
- Unidade de Endocrinologia do Desenvolvimento e Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil, .,Unidade de Endocrinologia Genetica (LIM/25), Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brazil,
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3
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Xargay-Torrent S, Dorado-Ceballos E, Benavides-Boixader A, Lizárraga-Mollinedo E, Mas-Parés B, Montesinos-Costa M, De Zegher F, Ibáñez L, Bassols J, López-Bermejo A. Circulating IGF-1 Independently Predicts Blood Pressure in Children With Higher Calcium-Phosphorus Product Levels. J Clin Endocrinol Metab 2020; 105:5601604. [PMID: 31633765 DOI: 10.1210/clinem/dgz101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/03/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To study the association between insulin-like growth factor 1 (IGF-1) and blood pressure in children, in particular, the potential interaction with the serum calcium-phosphorus product (Ca*P). METHODS A longitudinal study included 521 children (age 8.8 ± 0.1) from northeastern Spain, of whom 158 were followed-up after 5 years. IGF-1, insulin-like growth factor-binding protein 3 (IGFBP-3), and serum calcium and phosphorus were measured at baseline. Anthropometric (body-mass index [BMI] and waist) and cardiometabolic variables (systolic [SBP] and diastolic blood pressure), pulse pressure, insulin, homeostatic model assessment of insulin resistance [HOMA-IR], high-density lipoprotein [HDL]-cholesterol, and triglycerides) were assessed at baseline and at the end of follow-up. Statistical analysis included Pearson correlations followed by multivariable linear regression analyses. RESULTS Baseline IGF-1 and IGF-1/IGFBP-3 molar ratio positively correlated with baseline and follow-up BMI, waist, SBP, pulse pressure, insulin, HOMA-IR and triglycerides (r 0.138-0.603; all P < 0.05). The associations with SBP were stronger with increasing Ca*P (r 0.261-0.625 for IGF-1; and r 0.174-0.583 for IGF-1/IGFBP-3). After adjusting for confounding variables, baseline IGF-1 and IGF-1/IGFBP-3 remained independently associated with both baseline and follow-up SBP in children in the highest Ca*P tertile (β = 0.245-0.381; P < 0.01; model R2 = 0.246-0.566). CONCLUSIONS Our results suggest that IGF-1 in childhood is an independent predictor of SBP in apparently healthy children, especially in those with high Ca*P levels.
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Affiliation(s)
- Sílvia Xargay-Torrent
- Pediatric Endocrinology Research Group, (Girona Biomedical Research Institute) IDIBGI, Salt, Spain
| | | | - Anna Benavides-Boixader
- Pediatric Endocrinology Research Group, (Girona Biomedical Research Institute) IDIBGI, Salt, Spain
| | | | - Berta Mas-Parés
- Materno-Fetal Metabolic Research Group, (Girona Biomedical Research Institute) IDIBGI, Salt, Spain
| | | | - Francis De Zegher
- Department of Development & Regeneration, University of Leuven, Leuven, Belgium
| | - Lourdes Ibáñez
- Pediatric Endocrinology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), ISCIII, Madrid, Spain
| | - Judit Bassols
- Materno-Fetal Metabolic Research Group, (Girona Biomedical Research Institute) IDIBGI, Salt, Spain
| | - Abel López-Bermejo
- Pediatric Endocrinology Research Group, (Girona Biomedical Research Institute) IDIBGI, Salt, Spain
- Department of Pediatrics, Dr. Trueta University Hospital, Girona, Spain
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Schilbach K, Olsson DS, Boguszewski MCS, Bidlingmaier M, Johannsson G, Jørgensen JOL. Biomarkers of GH action in children and adults. Growth Horm IGF Res 2018; 40:1-8. [PMID: 29601998 DOI: 10.1016/j.ghir.2018.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/02/2018] [Accepted: 03/17/2018] [Indexed: 12/12/2022]
Abstract
Growth hormone (GH) and IGF-I levels in serum are used as biomarkers in the diagnosis and management of GH-related disorders but have not been subject to structured validation. Auxological parameters in children and changes in body composition in adults, as well as metabolic parameters and patient related outcomes are used as clinical and surrogate endpoints. New treatment options, such as long acting GH and GH antagonists, require reevaluation of the currently used biochemical biomarkers. This article will review biomarkers, surrogate endpoints and clinical endpoints related to GH treatment in children and adults as well as in acromegaly.
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Affiliation(s)
- Katharina Schilbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany.
| | - Daniel S Olsson
- Department of Internal medicine and clinical nutrition, Sahlgrenska academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margaret C S Boguszewski
- Department of Pediatrics, Endocrine Division (SEMPR), Federal University of Paraná, Curitiba, Brazil
| | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Gudmundur Johannsson
- Department of Internal medicine and clinical nutrition, Sahlgrenska academy, University of Gothenburg, Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Guzzetti C, Ibba A, Pilia S, Beltrami N, Di Iorgi N, Rollo A, Fratangeli N, Radetti G, Zucchini S, Maghnie M, Cappa M, Loche S. Cut-off limits of the peak GH response to stimulation tests for the diagnosis of GH deficiency in children and adolescents: study in patients with organic GHD. Eur J Endocrinol 2016; 175:41-7. [PMID: 27147639 DOI: 10.1530/eje-16-0105] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/04/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The diagnosis of GH deficiency (GHD) in children and adolescents is established when GH concentrations fail to reach an arbitrary cut-off level after at least two provocative tests. The objective of the study was to define the optimal GH cut-offs to provocative tests in children and adolescents. DESIGN Retrospective study in 372 subjects who underwent evaluation of GH secretion. GH and IGF-I were measured by chemiluminescence assay in all samples. Receiver operating characteristic (ROC) analysis was used to evaluate the optimal GH cut-offs and the diagnostic accuracy of provocative tests. METHODS Seventy four patients with organic GHD (GH peak <10μg/L after two provocative tests) and 298 control subjects (GH response >10μg/L to at least one test) were included in the study. The provocative tests used were arginine, insulin tolerance test (ITT) and clonidine. Diagnostic criteria based on cut-offs identified by ROC analysis (best pair of values for sensitivity and specificity) were evaluated for each test individually and for each test combined with IGF-I SDS. RESULTS The optimal GH cut-off for arginine resulted 6.5μg/L, 5.1μg/L for ITT and 6.8μg/L for clonidine. IGF-I SDS has low accuracy in diagnosing GHD (AUC=0.85). The combination of the results of provocative tests with IGF-I concentrations increased the specificity. CONCLUSIONS The results of the ROC analysis showed that the cut-off limits which discriminate between normal and GHD are lower than those commonly employed. IGF-I is characterized by low diagnostic accuracy.
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Affiliation(s)
- Chiara Guzzetti
- SSD Endocrinologia PediatricaOspedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Anastasia Ibba
- SSD Endocrinologia PediatricaOspedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | - Sabrina Pilia
- SSD Endocrinologia PediatricaOspedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
| | | | - Natascia Di Iorgi
- Clinica Pediatrica, Istituto Giannina Gaslini, Universitá di GenovaGenova, Italy
| | | | - Nadia Fratangeli
- Clinica Pediatrica, Istituto Giannina Gaslini, Universitá di GenovaGenova, Italy
| | | | | | - Mohamad Maghnie
- Clinica Pediatrica, Istituto Giannina Gaslini, Universitá di GenovaGenova, Italy
| | - Marco Cappa
- UOC di Endocrinologia e DiabetologiaOspedale Pediatrico Bambino Gesú IRCCS, Roma, Italy
| | - Sandro Loche
- SSD Endocrinologia PediatricaOspedale Pediatrico Microcitemico "A. Cao", Cagliari, Italy
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6
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Chesover AD, Dattani MT. Evaluation of growth hormone stimulation testing in children. Clin Endocrinol (Oxf) 2016; 84:708-14. [PMID: 26840536 DOI: 10.1111/cen.13035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/30/2015] [Accepted: 01/28/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the use and interpretation of growth hormone (GH) stimulation tests used across the UK for diagnosing GH deficiency. BACKGROUND Previous studies show poor consensus on the use of GH stimulation tests. Sex steroid priming and retesting in the transition period are areas not previously surveyed. DESIGN Data were collected from tertiary paediatric endocrinologists, paediatricians with a specialist interest in endocrinology and biochemists across the UK over 6 months through distributing electronic surveys. RESULTS At least three different GH stimulation tests were used by 33% of departments. Glucagon and insulin doses varied most, and sampling frequency varied most using insulin. All laboratories use a recommended chemiluminescence immunoassay with an acceptable coefficient of variability. The GH peak for diagnosing GH deficiency varied from 6 to 8 μg/l. A wide range of clinical scenarios prompted retesting in the transition period, suggesting nonstandardized current practice. Seventy-five per cent of departments use sex steroid priming, but follow criteria variously combining bone age, chronological age and pubertal stage, together with variations in steroid type and dose. CONCLUSIONS Although a contentious diagnostic test, GH stimulation tests remain the gold standard for diagnosing GH deficiency. Our data suggest that together with variation in indication, protocol and interpretation, there is considerable variation in current practices pertaining to priming and retesting in transition. Given the current financial climate and the need for careful resource management, this study emphasizes the considerable need for consensus in the investigation, diagnosis and long-term follow-up of these children, at least nationally if not internationally.
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Affiliation(s)
- Alexander D Chesover
- Department of Paediatrics, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Mehul T Dattani
- Department of Paediatric Endocrinology, UCL Institute of Child Health/Great Ormond Street Hospital for Children/UCL Hospitals, London, UK
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Abstract
The IGF system comprises two IGFs (IGF-1, IGF-2), two IGF-receptors (IGF-R1, IGF-R2), and six IGF binding proteins (IGFBPs) with a high affinity for IGFs. The IGFBPs, of which IGFBP-3 is the most abundant in postnatal blood, link with IGFs and prevent them from being degraded; they also facilitate IGF transport through body compartments. The interaction between IGFs and their specific receptors is partly regulated by structural modifications inherent to the IGFBPs. IGFBPs also have IGF-independent biological effects. Since serum IGFBP-3 is GH-dependent and correlates quantitatively with GH secretion, its measurement is useful in tests of abnormal GH secretion. Particularly during childhood, IGFBP-3 values play an important role in ascertaining alterations in GH secretion and action (i.e., primary IGF deficiency states). A new role for IGFBP-3 and other IGFBPs with natural or altered structures is likely to be established through current studies investigating their application in promoting apoptotic processes in malignancies.
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Affiliation(s)
- Michael B Ranke
- Division of Paediatric Endocrinology, University Children's Hospital, Tübingen, Germany.
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Bizzarri C, Pedicelli S, Boscherini B, Bedogni G, Cappa M, Cianfarani S. Early retesting by GHRH + arginine test shows normal GH response in most children with idiopathic GH deficiency. J Endocrinol Invest 2015; 38:429-36. [PMID: 25376365 DOI: 10.1007/s40618-014-0205-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Most children with idiopathic isolated GH deficiency (IGHD) normalize GH response to stimulation tests when retested at the completion of growth. The objective of this study was to test the effectiveness of early retesting in challenging the diagnosis of idiopathic IGHD and critically review the diagnostic workup leading to this diagnosis in children with short stature. METHODS We cross-sectionally retested 38 children with idiopathic IGHD and still on GH treatment. The initial diagnosis of idiopathic IGHD was based on subnormal GH responses to two stimulation tests and normal brain imaging or minor/nonspecific findings at magnetic resonance. The GH response normalization at retesting was considered as the main outcome measure. Clinical features of children who were falsely classified as idiopathic IGHD based on first GH testing were retrospectively analyzed. RESULTS GH secretion was normal in 36/38 children (95%). Two children showed slightly reduced peak GH responses and normal IGF-I levels. Fourteen children underwent GH retesting before puberty, 24 children during puberty. CONCLUSION The diagnostic process should be improved to minimize the rate of false positive at GH testing and, in case of unsatisfactory response to GH treatment, the diagnosis of isolated idiopathic GHD should be challenged with early retesting.
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Affiliation(s)
- C Bizzarri
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - S Pedicelli
- D.P.U.O. Bambino Gesù Children's Hospital, "Tor Vergata" University, Rome, Italy
| | | | - G Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Basovizza and Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - M Cappa
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - S Cianfarani
- D.P.U.O. Bambino Gesù Children's Hospital, "Tor Vergata" University, Rome, Italy
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Shen Y, Zhang J, Zhao Y, Yan Y, Liu Y, Cai J. Diagnostic value of serum IGF-1 and IGFBP-3 in growth hormone deficiency: a systematic review with meta-analysis. Eur J Pediatr 2015; 174:419-27. [PMID: 25213432 DOI: 10.1007/s00431-014-2406-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/08/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) are conventionally considered available for the diagnosis of growth hormone deficiency (GHD), but the results about their diagnostic values are inconsistent among some recent epidemiological studies. The aim of this study is to assess the diagnostic values of serum IGF-1 and IGFBP-3 for GHD by conducting a systematic review and meta-analysis. Studies on serum IGF-1 and IGFBP-3 used in GHD diagnosis were systematically searched from databases PubMed, EMBASE, and CNKI (up to December 2013). Characteristics of the studies and data were independently collected according to the inclusion criteria by two authors. The quality of included studies was assessed using quality assessment of diagnostic accuracy studies (QUADAS). Both sensitivity (SEN) and specificity (SPE) of IGF-1 and IGFBP-3 in GHD diagnosis were estimated on statistical software Meta-DiSc and Stata. A total of 12 studies were included for the final analysis. IGF-1 had SEN of 0.66, SPE of 0.69, positive likelihood ratio (PLR) of 2.48, negative likelihood ratio (NLR) of 0.51, area under the summary receiver operating characteristic curve (SROC) of 0.78, and Q* value of 0.72. Serum IGFBP-3 had SEN of 0.50, SPE of 0.79, PLR of 2.69, NLR of 0.64, area under SROC of 0.80, and Q* value of 0.73. CONCLUSION Serum IGF-1 and IGFBP-3 are useful for the diagnosis of GHD and can be utilized as auxiliary diagnosis indexes for provocative test.
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Affiliation(s)
- Yi Shen
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, Jiangsu, China,
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Fernandez-Rodriguez E, Bernabeu I, Andujar-Plata P, Casanueva FF. Subclinical hypopituitarism. Best Pract Res Clin Endocrinol Metab 2012; 26:461-9. [PMID: 22863388 DOI: 10.1016/j.beem.2011.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The presence of subclinical or minor pituitary hormone deficiencies could be recognised in clinical practice and might represent intermediate situations among normal pituitary hormone secretion and clinical hypopituitarism. However, this entity has not been correctly identified and associated clinical impairment and even more, long-term consequences regarding to morbidity and mortality, strongly related to clinical hypopituitarism, has not been correctly settled. Furthermore, best test or methods for diagnosis and the cut off to define these intermediate situates are also unknown. With this purpose, long-term controlled studies are needed to define correctly this entity, the appropriate methods for diagnosis and the potential benefits of substitutive hormone therapy in detected cases. The present review will focus on the available evidence concerning the prevalence, clinical features and diagnosis of subclinical hypopituitarism.
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Affiliation(s)
- Eva Fernandez-Rodriguez
- Endocrinology Division, Complejo Hospitalario Universitario de Santiago de Compostela (CHUS), SERGAS, Departamento de Medicina, Universidad de Santiago de Compostela, Travesía da Choupana s/n. 15706 Santiago de Compostela, La Coruña, Spain
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Hua C, Wu S, Chemaitilly W, Lukose RC, Merchant TE. Predicting the probability of abnormal stimulated growth hormone response in children after radiotherapy for brain tumors. Int J Radiat Oncol Biol Phys 2012; 84:990-5. [PMID: 22483696 DOI: 10.1016/j.ijrobp.2012.01.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/13/2012] [Accepted: 01/16/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To develop a mathematical model utilizing more readily available measures than stimulation tests that identifies brain tumor survivors with high likelihood of abnormal growth hormone secretion after radiotherapy (RT), to avoid late recognition and a consequent delay in growth hormone replacement therapy. METHODS AND MATERIALS We analyzed 191 prospectively collected post-RT evaluations of peak growth hormone level (arginine tolerance/levodopa stimulation test), serum insulin-like growth factor 1 (IGF-1), IGF-binding protein 3, height, weight, growth velocity, and body mass index in 106 children and adolescents treated for ependymoma (n=72), low-grade glioma (n=28) or craniopharyngioma (n=6), who had normal growth hormone levels before RT. Normal level in this study was defined as the peak growth hormone response to the stimulation test≥7 ng/mL. RESULTS Independent predictor variables identified by multivariate logistic regression with high statistical significance (p<0.0001) included IGF-1 z score, weight z score, and hypothalamic dose. The developed predictive model demonstrated a strong discriminatory power with an area under the receiver operating characteristic curve of 0.883. At a potential cutoff point of probability of 0.3 the sensitivity was 80% and specificity 78%. CONCLUSIONS Without unpleasant and expensive frequent stimulation tests, our model provides a quantitative approach to closely follow the growth hormone secretory capacity of brain tumor survivors. It allows identification of high-risk children for subsequent confirmatory tests and in-depth workup for diagnosis of growth hormone deficiency.
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Affiliation(s)
- Chiaho Hua
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
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Kayemba-Kay's S, Epstein S, Hindmarsh P, Burguet A, Ingrand P, Hankard R. Does plasma IGF-BP3 measurement contribute to the diagnosis of growth hormone deficiency in children? ANNALES D'ENDOCRINOLOGIE 2011; 72:218-23. [PMID: 21641574 DOI: 10.1016/j.ando.2011.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 09/01/2010] [Accepted: 01/06/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To audit the contribution of plasma IGF-PB3 measurement to the diagnosis of growth hormone deficiency (GHD) in children. POPULATION AND METHODS Retrospective case study including boys and girls aged 0 to 18 years who attended our paediatric endocrinology clinic for short stature and/or post-irradiation follow-up, and had at least one GH provocative testing. Children with hypothyroidism, Laron or Kowarski syndromes, severe malnutrition, chronic renal failure and liver failure were excluded. RESULTS Fifty-eight children were enrolled and grouped as GHD [+] (19 cases) and GDH [-] (39 cases). IGF-I and IGF-BP3 assay was carried out in 88% and 62% cases respectively, both groups were comparable for age, sex, BMI, target height, pubertal stage and bone age. There was a significant difference in peak GH between GDH [-] and GHD [+] groups (41.8 mUI/L ± 21.7 versus 11.5 ± 5.9 mUI/L, P<0.00001, respectively). No difference was found between groups with regards to IGF-I Z-scores and IGF-BP3 Z-scores. There was, however, a positive correlation between IGF-I Z-scores and IGF-BP3 Z-scores (r=0.50; P<0.0016). IGF-BP3 measurement could not differentiate between GHD [+] and GHD [-] groups. CONCLUSIONS Measurement of plasma IGF-BP3 level contributes poorly to the diagnosis of GHD. We do not recommend it in routine use.
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Affiliation(s)
- S Kayemba-Kay's
- Paediatric Endocrinology Unit, Department of Pediatrics, Poitiers University Teaching Hospital, France.
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13
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Loche S, Guzzetti C, Pilia S, Ibba A, Civolani P, Porcu M, Minerba L, Casini MR. Effect of body mass index on the growth hormone response to clonidine stimulation testing in children with short stature. Clin Endocrinol (Oxf) 2011; 74:726-31. [PMID: 21521260 DOI: 10.1111/j.1365-2265.2011.03988.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES An inverse relationship has been shown between body mass index (BMI) and the peak growth hormone (GH) response to stimulation in adults and in children with short stature. This relation is observed even within a normal range of BMI. The aim of this study was to investigate the effect of BMI on the GH response to clonidine in a large number of children with short stature. DESIGN We conducted a retrospective study on the GH response to clonidine in a single centre. METHODS We studied 202 children with short stature (135 M and 67 F) who underwent clonidine testing from 2007 to 2009. RESULTS One hundred and twenty-eight patients had a GH peak >10 μg/l. In univariate regression analysis, the peak GH after clonidine was negatively correlated with BMI-standard deviation score (BMI-SDS) and positively correlated with height velocity-SDS and IGF-I-SDS. Only the relationship between peak GH and BMI-SDS remained significant in children with a BMI-SDS from -2 to +2. In the multivariate stepwise regression analysis, BMI-SDS and IGF-I-SDS were the only significant variables in the entire cohort, explaining 19·5% of the variance in peak GH. When only subjects with BMI-SDS between -2·0 and +2·0 were included in the analysis (n = 173), BMI-SDS alone explained 21·4% of the variability in peak GH. The number of patients who failed the clonidine test increased with increasing BMI-SDS. CONCLUSIONS BMI affects the GH response to clonidine in children with short stature and should be considered when interpreting the results to the stimulation test.
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Affiliation(s)
- Sandro Loche
- Servizio di Endocrinologia Pediatrica, Ospedale Microcitemico, ASL Cagliari, Cagliari, Italy.
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Smyczyńska J, Stawerska R, Lewiński A, Hilczer M. Do IGF-I concentrations better reflect growth hormone (GH) action in children with short stature than the results of GH stimulating tests? Evidence from the simultaneous assessment of thyroid function. Thyroid Res 2011; 4:6. [PMID: 21232100 PMCID: PMC3033853 DOI: 10.1186/1756-6614-4-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 01/13/2011] [Indexed: 11/12/2022] Open
Abstract
Background The diagnosis of growth hormone (GH) deficiency (GHD) in short children seems unquestionable when both GH peak in stimulating tests (GHST) and IGF-I concentration are decreased. However, the discrepancies between the results of GHST and IGF-I secretion are observed. It seems purposeful to determine the significance of GHST and IGF-I assessment in diagnosing GHD. The relationship between GH secretion and thyroid function, as well as GH influence on the peripheral thyroxine (T4) to triiodothyronine (T3) deiodination, mediated by IGF-I, were identified. Thus, clear differences in thyroid function between GH-deficient and non-GH-deficient subjects should exist. Methods Analysis comprised 800 children (541 boys), age 11.6 ± 3.1 years (mean ± SD), with short stature, in whom two (2) standard GHST (with clonidine and with glucagon) were performed and IGF-I, free T4 (FT4), free T3 (FT3) and TSH serum concentrations were assessed. The patients were qualified to the following groups: GHD - decreased GH peak in GHST and IGF-I SDS (n = 81), ISS - normal GH peak and IGF-I SDS (n = 347), low GH - normal IGF-I SDS, and decreased GH peak (n = 212), low IGF - decreased IGF-I SDS, and normal GH peak (n = 160). The relationships among the results of particular tests were evaluated. Results In the groups with decreased IGF-I concentrations (GHD Group and low IGF Group), the more severe deficit of height was observed, together with higher TSH and FT4 but lower FT3 levels than in groups with normal IGF-I concentrations (ISS Group and low GH Group), independently of the results of GHST. TSH, FT4 and FT3 concentrations were - respectively - similar in two groups with decreased IGF-I secretion, as well as in two groups with normal IGF-I levels. Significant correlations were found between patients' height SDS and IGF-I SDS, between FT3 and IGF-I SDS (positive), and between FT4 and IGF-I SDS (negative), with no correlation between GH peak and any of the parameters analyzed. Conclusion The assessment of thyroid function in children with short stature provides the evidence that measurement of IGF-I concentration may be a procedure reliable at least to the some degree in diagnosing GHD as the results of GHST.
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Affiliation(s)
- Joanna Smyczyńska
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland.
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15
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Leptin expression and leptin receptor gene polymorphisms in growth hormone deficiency patients. Hum Genet 2011; 129:455-62. [DOI: 10.1007/s00439-010-0941-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 12/22/2010] [Indexed: 12/13/2022]
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16
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Petersenn S, Quabbe HJ, Schöfl C, Stalla GK, von Werder K, Buchfelder M. The rational use of pituitary stimulation tests. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:437-43. [PMID: 20644702 DOI: 10.3238/arztebl.2010.0437] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 11/23/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diseases of the pituitary gland can lead to the dysfunction of individual hormonal axes and to the corresponding clinical manifestations. The diagnostic assessment of pituitary function has not yet been standardized. METHODS The members of the Neuroendocrinology Section and the Pituitary Study Group of the German Society for Endocrinology (Deutsche Gesellschaft für Endokrinologie) prepared outlines of diagnostic methods for the evaluation of each of the pituitary hormonal axes. These outlines were discussed in open session in recent annual meetings of the Section and the Study Group. RESULTS For the evaluation of the thyrotropic axis, basal TSH and free T4 usually suffice. For the evaluation of the gonadotropic axis in men, the testosterone level should be measured; if the overall testosterone level is near normal, then calculating the free testosterone level may be additionally useful. In women, an intact menstrual cycle is sufficient proof of normal function. In the absence of regular menstruation, measurement of the basal estradiol and gonadotropin levels aids in the diagnosis of the disturbance. For the evaluation of the adrenocorticotropic axis, the basal cortisol level may be helpful; provocative testing is in many cases necessary for precise characterization. The evaluation of the somato-tropic axis requires provocative testing. Aside from the insulin tolerance test, the GHRH-arginine test has become well established. Reference ranges normed to the body mass index (BMI) are available. CONCLUSION The diagnostic evaluation of pituitary insufficiency should proceed in stepwise fashion, depending on the patient's clinical manifestations and underlying disease. For some pituitary axes, measurement of basal hormone levels suffices; for others, stimulation tests are required. In general, the performance of combined pituitary tests should be viewed with caution.
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17
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Binder G, Brämswig J, Kratzsch J, Pfäffle R, Woelfle J. Leitlinie zur Diagnostik des Wachstumshormonmangels im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-2049-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paula LPD, Czepielewski MA. [Evaluating diagnosis methods on childhood GH (DGH) deficiency: IGFs, IGFBPs, releasing tests, GH rhythm and image exams]. ACTA ACUST UNITED AC 2009; 52:734-44. [PMID: 18797579 DOI: 10.1590/s0004-27302008000500004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 06/17/2008] [Indexed: 11/21/2022]
Abstract
The diagnostic approach to growth hormone deficiency (GHD) in children with short stature (SS) is controversial. Here we review the available methodology and present prospective data obtained in a cohort of patients with SS suggesting the use of screening test followed by the confirmation test. Thus, the children with SS should be submitted to clinical and laboratorial evaluation to exclude of chronic and genetic diseases. In addition patients with height<3 percentile or growth velocity<percentile 25, IGF-1 levels should be measured. If the IGF1 levels<-1 standard deviation (SD) compared to the age, GHD should be confirmed by two GH-stimulations tests (peak<5 mcg/L). In risk factor patients, IGF-1<-1 SD and one non-responsible GH-test, the GHD was confirmed. Children with IGF-1>-1 SD, the growth velocity should have observed and GH/IGF-1 axis re-evaluated if the growth pattern is not satisfactory.
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Affiliation(s)
- Leila Pedroso de Paula
- Serviço de Endicrinologia, Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Metabolismo e Nutrição, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brazil.
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19
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Haghshenas Z, Sotoudeh K, Karamifar H, Karamizadeh Z, Amirhakimi G. The role of insulin like growth factor (IGF)-1 and IGF-binding protein-3 in diagnosis of Growth Hormone Deficiency in short stature children. Indian J Pediatr 2009; 76:699-703. [PMID: 19381505 DOI: 10.1007/s12098-009-0115-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Accepted: 12/05/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the role of IGF-1 and IGFBP-3 in diagnosis of short stature children and adolescents in whom Growth Hormone Deficiency (GHD) was found. METHODS In this cross sectional study the referred short stature children and adolescents to Namazi Hospital in Shiraz- Iran, in 2003-2005 were studied. The inclusion criteria were proved short stature based on the physical examination, weight, height, standard deviation score (SDS) of height < -2, with considering stage of puberty and predicted height in children without any genetic or chronic disorders. The exclusion criteria were any positive physical or laboratory data suggesting hypothyroidism, rickets or liver disorders. For all patients a provocative growth hormone test was performed with propranolol and L-dopa and serum IGF-1 and IGFBP-3 were measured. GHD defined as peak(cutoff) serum GH level under 10 ìg/L and low IGF-1 and IGFBP-3 considered as cutoff serum level under -2 standard deviation. RESULTS Eighty one short stature patients (39 boys and 42 girls) with mean age of 10.6 +/- 3.5 years completed the study. Seventeen patients with GHD were found and in 18 patients IGF-1 level were low. Only in 6 patients both GH and IGF-1 were low and 2 of them had low IGFBP-3. There were no correlations between the levels of GH,IGF-1 and IGFBP-3 in children with short stature due to GHD. The sensitivity and specifity of IGF-1 and IGFBP-3 in assessment of GHD were 35% and 81% for IGF-1 and 12% and 94% for IGFBP-3, respectively. CONCLUSION No correlations were found between GH level and serum levels of IGF-1 and IGFBP-3 in short patients and the sensitivity of those tests in assessment of GHD were poor.
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Affiliation(s)
- Zahra Haghshenas
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
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20
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Mattsson A, Svensson D, Schuett B, Osterziel KJ, Ranke MB. Multidimensional reference regions for IGF-I, IGFBP-2 and IGFBP-3 concentrations in serum of healthy adults. Growth Horm IGF Res 2008; 18:506-516. [PMID: 18550406 DOI: 10.1016/j.ghir.2008.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 04/03/2008] [Accepted: 04/25/2008] [Indexed: 01/25/2023]
Abstract
CONTEXT The insulin-like growth factor (IGF) system exerts many effects on the growth and differentiation of both normal and malignant cells. The serum concentrations of insulin-like growth factor I (S-IGF-I), insulin-like growth factor-binding protein 2 (S-IGFBP-2) and insulin-like growth factor-binding protein 3 (S-IGFBP-3) and their inter-relations may differ in certain disease states from those seen in healthy individuals. OBJECTIVE To estimate age-, gender- and body mass index (BMI)-specific univariate, bivariate and trivariate 95% reference regions for these components in healthy adults and present indices that will facilitate interpretation of patient observations in relation to these reference regions. DESIGN Blood samples were taken in the morning from 427 healthy, non-fasting German blood donors of both genders (age range, 18-79 years; BMI range, 16-44 kg/m(2)). Reference regions were developed with multivariate regression methods. RESULTS Regression analyses showed that S-IGF-I and S-IGFBP-3 levels decrease with increasing age, whereas S-IGFBP-2 concentrations increase with age (P<0.0001). Females had significantly higher S-IGFBP-3 levels than males (P<0.0001) and similar S-IGF-I and S-IGFBP-2 concentrations. Increasing BMI was associated with decreasing S-IGFBP-2 (P<0.0001), but was not significantly associated with the concentrations of the other two analytes. Controlling for age, gender and BMI, S-IGF-I and S-IGFBP-3 were positively correlated (r=0.58), whereas S-IGF-I and S-IGFBP-2, and S-IGFBP-2 and S-IGFBP-3 were negatively correlated (r=-0.11 and r=-0.18, respectively). Based on the regression models, which were controlled for age, gender and BMI, two- and three-dimensional 95% reference regions with associated patient indices were described for each pair of analytes and for the trio of analytes, respectively. CONCLUSIONS The multivariate reference regions developed in this study should be useful in identifying patients with an abnormal IGF-IGFBP axis. It is suggested that introducing multidimensional reference regions and the described patient indices into clinical practice may aid monitoring of the safety of GH therapy. These patient indices may also be useful in the assessment of cancer risk.
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Affiliation(s)
- Anders Mattsson
- KIMS Medical Outcomes, Pfizer Endocrine Care, Stockholm, Sweden.
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21
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Wit JM, Clayton PE, Rogol AD, Savage MO, Saenger PH, Cohen P. Idiopathic short stature: definition, epidemiology, and diagnostic evaluation. Growth Horm IGF Res 2008; 18:89-110. [PMID: 18182313 DOI: 10.1016/j.ghir.2007.11.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 02/08/2023]
Abstract
Idiopathic short stature is a condition in which the height of the individual is more than 2 SD below the corresponding mean height for a given age, sex and population, in whom no identifiable disorder is present. It can be subcategorized into familial and non-familial ISS, and according to pubertal delay. It should be differentiated from dysmorphic syndromes, skeletal dysplasias, short stature secondary to a small birth size (small for gestational age, SGA), and systemic and endocrine diseases. ISS is the diagnostic group that remains after excluding known conditions in short children.
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Affiliation(s)
- J M Wit
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
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22
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Hauffa BP, Lehmann N, Bettendorf M, Mehls O, Dörr HG, Stahnke N, Steinkamp H, Said E, Ranke MB. Central laboratory reassessment of IGF-I, IGF-binding protein-3, and GH serum concentrations measured at local treatment centers in growth-impaired children: implications for the agreement between outpatient screening and the results of somatotropic axis functional testing. Eur J Endocrinol 2007; 157:597-603. [PMID: 17984239 DOI: 10.1530/eje-07-0338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Childhood GH deficiency, suspected in the presence of decreased height velocity and short stature, is usually characterized by low IGF-I and IGF-binding protein-3 (IGFBP-3) serum concentrations and is conventionally confirmed by diminished GH peak responses to pharmacological stimuli. OBJECTIVE We evaluated the agreement between different IGF-I (IGFBP-3) assays in predicting GH deficiency and tested whether variability between growth factor screening and pharmacological testing could be diminished by reassessment of growth factor and GH peak concentrations in a single laboratory. DESIGN Using the Tuebingen IGF-I (IGFBP-3) RIA, 317 (321) sera from children evaluated for growth disorders in 19 centers were reanalyzed. In 103 children with insulin hypoglycemia and arginine tests, we evaluated how the association between the outcome of growth factor screening and functional testing would change if different assays were employed. RESULTS Locally measured IGF-I correlated better than IGFBP-3 with the results of the central laboratory (Tuebingen) assay (slope of the regression curve 1.05; 95% confidence interval (95% CI) 1.01-1.1 versus 1.18; 95% CI 1.09-1.3). Agreement between local and central laboratory assays in predicting GH deficiency was better for IGF-I than for IGFBP-3 assays (kappa =0.59 versus kappa =0.47). The poor agreement between growth factor screening and GH pharmacological testing was not improved when hormone concentrations were remeasured in the central laboratory (kappa local=-0.0031, central=0.12). CONCLUSIONS In children with impaired growth, growth factor screening reflects different aspects of GH insufficiency than does functional testing. Agreement between these approaches is poor and could not be improved by reduction of assay-related variability.
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Affiliation(s)
- Berthold P Hauffa
- Division of Pediatric Endocrinology and Diabetology, University Children's Hospital, Heidelberg, Germany.
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23
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Clemmons DR. Value of insulin-like growth factor system markers in the assessment of growth hormone status. Endocrinol Metab Clin North Am 2007; 36:109-29. [PMID: 17336738 DOI: 10.1016/j.ecl.2006.11.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Insulin-like growth factor-I (IGF-I) has been measured extensively in a variety of clinical settings. Total IGF-I frequently is used to assess the clinical impact of disorders of GH secretion and to monitor patients' response to therapy. It does not have sufficient precision to be used as a stand-alone test in the diagnosis of GH deficiency. Free IGF-I, IGF binding protein-3, or acid-labile subunit may provide useful information regarding GH secretion in specific conditions but are not superior to IGF-I for making the diagnosis of GH deficiency or acromegaly.
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Affiliation(s)
- David R Clemmons
- Division of Endocrinology, University of North Carolina School of Medicine, University of North Carolina, CB #7170, 8024 Burnett-Womack, Chapel Hill, NC 27599, USA.
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Federico G, Street ME, Maghnie M, Caruso-Nicoletti M, Loche S, Bertelloni S, Cianfarani S. Assessment of serum IGF-I concentrations in the diagnosis of isolated childhood-onset GH deficiency: a proposal of the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP/ISPED). J Endocrinol Invest 2006; 29:732-7. [PMID: 17033263 DOI: 10.1007/bf03344184] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The diagnosis of GH deficiency (GHD) is based on the measurement of peak GH responses to pharmacological stimuli. Pharmacological stimuli, however, lack precision, accuracy, are not reproducible, are invasive, non-physiological and some may even be hazardous. Furthermore, different GH commercial assays used to measure GH in serum yield results that may differ considerably. In contrast to GH, IGF-I can be measured on a single, randomly-obtained blood sample. A review of the available data indicates that IGF-I measurement in the diagnosis of childhood-onset isolated GHD has a specificity of up to 100%, with a sensitivity ranging from about 70 to 90%. We suggest an algorithm in which circulating levels of IGF-I together with the evaluation of auxological data, such as growth rate and growth, may be used to assess the likelihood of GHD in pre-pubertal children.
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Affiliation(s)
- G Federico
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Pisana, 56125 Pisa, Italy.
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25
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Kelberman D, Rizzoti K, Avilion A, Bitner-Glindzicz M, Cianfarani S, Collins J, Chong WK, Kirk JM, Achermann JC, Ross R, Carmignac D, Lovell-Badge R, Robinson IC, Dattani MT. Mutations within Sox2/SOX2 are associated with abnormalities in the hypothalamo-pituitary-gonadal axis in mice and humans. J Clin Invest 2006; 116:2442-55. [PMID: 16932809 PMCID: PMC1551933 DOI: 10.1172/jci28658] [Citation(s) in RCA: 138] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Accepted: 06/20/2006] [Indexed: 02/06/2023] Open
Abstract
The transcription factor SOX2 is expressed most notably in the developing CNS and placodes, where it plays critical roles in embryogenesis. Heterozygous de novo mutations in SOX2 have previously been associated with bilateral anophthalmia/microphthalmia, developmental delay, short stature, and male genital tract abnormalities. Here we investigated the role of Sox2 in murine pituitary development. Mice heterozygous for a targeted disruption of Sox2 did not manifest eye defects, but showed abnormal anterior pituitary development with reduced levels of growth hormone, luteinizing hormone, and thyroid-stimulating hormone. Consequently, we identified 8 individuals (from a cohort of 235 patients) with heterozygous sequence variations in SOX2. Six of these were de novo mutations, predicted to result in truncated protein products, that exhibited partial or complete loss of function (DNA binding, nuclear translocation, or transactivation). Clinical evaluation revealed that, in addition to bilateral eye defects, SOX2 mutations were associated with anterior pituitary hypoplasia and hypogonadotropic hypogonadism, variable defects affecting the corpus callosum and mesial temporal structures, hypothalamic hamartoma, sensorineural hearing loss, and esophageal atresia. Our data show that SOX2 is necessary for the normal development and function of the hypothalamo-pituitary and reproductive axes in both humans and mice.
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Affiliation(s)
- Daniel Kelberman
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Karine Rizzoti
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Ariel Avilion
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Maria Bitner-Glindzicz
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Stefano Cianfarani
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Julie Collins
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - W. Kling Chong
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Jeremy M.W. Kirk
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - John C. Achermann
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Richard Ross
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Danielle Carmignac
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Robin Lovell-Badge
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Iain C.A.F. Robinson
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
| | - Mehul T. Dattani
- London Centre for Paediatric Endocrinology, Biochemistry, Endocrinology, and Metabolism Unit, and
Clinical and Molecular Genetics Unit, Institute of Child Health, University College London, London, United Kingdom.
Division of Developmental Genetics, Medical Research Council National Institute for Medical Research, London, United Kingdom.
Cancer Research UK, Skin Tumour Lab, University of London, London, United Kingdom.
Center of Paediatric Endocrinology, Department of Public Health and Cell Biology, “Tor Vergata” University, Rome, Italy.
Department of Radiology, Great Ormond Street Hospital for Children National Health Service (NHS) Trust, London, United Kingdom.
Department of Paediatric Endocrinology, Birmingham Children’s Hospital, Birmingham, United Kingdom.
Division of Clinical Sciences, University of Sheffield, Sheffield, United Kingdom.
Division of Molecular Neuroendocrinology, Medical Research Council National Institute for Medical Research, London, United Kingdom
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26
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Mehta A, Hindmarsh PC, Stanhope RG, Turton JPG, Cole TJ, Preece MA, Dattani MT. The role of growth hormone in determining birth size and early postnatal growth, using congenital growth hormone deficiency (GHD) as a model. Clin Endocrinol (Oxf) 2005; 63:223-31. [PMID: 16060918 DOI: 10.1111/j.1365-2265.2005.02330.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The role of GH in early human growth is unclear. Congenital GH deficiency (CGHD) provides a useful tool to explore this putative role. We have assessed the effects of CGHD on birth size and early postnatal growth, and the further impact of the presence of additional pituitary hormone deficiencies and midline brain defects on these parameters. DESIGN, PATIENTS AND MEASUREMENTS Weight, length and BMI expressed as standard deviation scores (SDS), over the first two years of life, were retrospectively compared in 44 GH-deficient children (M:F 26 : 18). Thirty-eight of 44 patients underwent GH provocation testing and all patients had neuro-imaging of the brain. The patients were divided into three groups of increasing phenotypic complexity {group A [n = 12, isolated GHD, no midline defects], group B [n = 10, combined pituitary hormone deficiency (CPHD); no midline defects], group C (n = 22, CPHD with midline defects)}. RESULTS Mean birth weight, length and BMI SDS were -0.4, -0.9 and +0.1 SDS, respectively. The differences were significant for weight (P = 0.03) and BMI (P = 0.003), but not length (P = 0.3) SDS, between groups A and C. Of the three groups, group A had a lower weight and BMI SDS than group C. The prevalence of postnatal complications (n = 25) was significantly different in the three groups [group A (8%), group B (80%), group C (73%); P < 0.001] and particularly between patients with isolated GH deficiency (IGHD) (group A) and CPHD (groups B and C; P < 0.0001). No patients in group A presented with neonatal hypoglycaemia as compared with 70% of those in group B and 59% in group C (P = 0.001). A reduced length SDS was observed in all patients within 6 months of birth and the reduction was greatest in group B (P = 0.03). Group C remained significantly (P < 0.05) heavier at 12, 18 and 24 months compared to group A. BMI SDS was significantly (P < 0.05) greater at all study points in CPHD patients (groups B and C) as compared with IGHD. Serum GH concentrations at testing did not correlate significantly with birth length (r = -0.08, P = 0.7), birth weight (r = -0.08, P = 0.6) or the age at induction of GH treatment (r = 0.12, P = 0.5). There were no significant differences between peak serum GH concentrations in patients in groups A (7.8 +/- 6.3 mU/l), B (3.9 +/- 4.8 mU/l) or C (8.7 +/- 5.4 mU/l). CONCLUSIONS Length, weight and BMI data from our study groups suggest that GH per se has a minimal effect on intrauterine growth but a significant effect during the infancy period. Early growth may also be influenced by the complexity of the hypopituitary phenotype reflected by the presence of additional pituitary hormone deficiencies and midline forebrain defects.
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Affiliation(s)
- Ameeta Mehta
- London Centre for Paediatric Endocrinology and Metabolism, Institute of Child Health, University College London, London, UK
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27
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Ranke MB, Schweizer R, Lindberg A, Price DA, Reiter EO, Albertsson-Wikland K, Darendeliler F, Darendelliler F. Insulin-like growth factors as diagnostic tools in growth hormone deficiency during childhood and adolescence: the KIGS experience. HORMONE RESEARCH 2005; 62 Suppl 1:17-25. [PMID: 15761228 DOI: 10.1159/000080754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Growth hormone (GH) deficiency in children covers a spectrum of disorders involving an impairment in GH secretion and a clinical syndrome characterized by permanent stunting of growth. Ascertaining impairments in GH secretion directly is complex, especially if GH deficiency (GHD) is isolated and not caused by congenital or acquired pituitary defects or genetic abnormalities. It has been established that the concentrations of GH-dependent peptides, such as insulin-like growth factor I (IGF-I) and IGF-binding protein 3 (IGFBP-3), are low in patients with GHD. Their levels are, however, also influenced by a multitude of factors, such as age, gender, height, liver function, nutritional status and other hormones. In addition, the type of complex formed, e.g. either binary or ternary, may influence the measurements of IGFs and their binding proteins. Therefore, levels of IGF-I and IGFBP-3 are generally lower in short children compared with age-matched norms. The reported diagnostic value of sub-normal basal levels of IGF-I and IGFBP-3 is, in terms of sensitivity and specificity, approximately 70%. Thus, definite proof of GHD can only be achieved by means of GH measurements. As the diagnosis of GHD is somewhat unlikely if IGF testing shows normal values, it is clearly advantageous to schedule these tests as part of the initial diagnostic work-up in short children, as their implementation is not only practical but also inexpensive. The Pfizer International Growth Database (KIGS) analysis of IGF-I (n = 2,750) and IGFBP-3 (n = 1,300) levels in children with idiopathic GHD shows that these two parameters are now firmly embedded in diagnostic strategies around the world.
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Affiliation(s)
- Michael B Ranke
- Paediatric Endocrinology Section, University Children's Hospital, Tubingen, Germany.
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28
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Cole TJ, Hindmarsh PC, Dunger DB. Growth hormone (GH) provocation tests and the response to GH treatment in GH deficiency. Arch Dis Child 2004; 89:1024-7. [PMID: 15499055 PMCID: PMC1719706 DOI: 10.1136/adc.2003.043406] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify factors, particularly the growth hormone (GH) provocation test result, affecting growth response to GH treatment in children with GH deficiency (GHD). SUBJECTS A total of 337 prepubertal GHD patients aged <10 years from the UK Pharmacia KIGS database (GH response to provocation test <20 mU/l). OUTCOME MEASURE Annual change in height standard deviation score (SDS) (revised UK reference) in the first and second years of treatment. RESULTS Height increased by 0.74 SDS units (SD 0.39) in the first year of treatment and 0.37 units (SD 0.27) in the second. Adjusting for age, height, weight, midparent height, and injection frequency, the strongest predictor of first year growth response was the GH provocation test result; halving the result predicted an extra height increment of 0.09 units (p<0.0001). It predicted the second year response less well (p<0.0002) and after adjusting for the first year response was not predictive at all. CONCLUSIONS Among patients referred for possible GHD, the GH provocation test, though not a gold standard for diagnosis, is a valuable predictor of growth response in the first year of treatment. A year's treatment is recommended for cases with a marginal provocation test result, with the option to continue treatment if the response is adequate. The value of unified protocols for single or repeated provocation tests needs to be assessed.
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Affiliation(s)
- T J Cole
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London, UK.
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29
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Abstract
Advances in molecular biology have led to the identification of mutations within several novel genes associated with the phenotype of isolated growth hormone deficiency, combined pituitary hormone deficiency, and syndromes such as septo-optic dysplasia. Progress has also been made in terms of the optimum diagnosis of disorders of stature and their treatment. The use of growth hormone for the treatment of adults with growth hormone deficiency and conditions such as Turner's syndrome, Prader-Willi syndrome, intrauterine growth restriction, and chronic renal failure has changed the practice of endocrinology, although cost-benefit implications remain to be established.
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Affiliation(s)
- Mehul Dattani
- Institute of Child Health, University College London, London WC1N 1EH, UK
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30
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Gandrud LM, Wilson DM. Is growth hormone stimulation testing in children still appropriate? Growth Horm IGF Res 2004; 14:185-194. [PMID: 15125879 DOI: 10.1016/j.ghir.2003.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2003] [Revised: 11/15/2003] [Accepted: 11/18/2003] [Indexed: 10/26/2022]
Abstract
The diagnosis of growth hormone deficiency (GHD) historically has relied on measurement of growth hormone (GH) concentrations following stimulation, usually with a non-physiologic provocative agent. Despite the use of more specific GH assays, the peak concentration of GH below which a child is considered GH deficient has risen. We examine the pitfalls associated with GH stimulation tests, specifically, the lack of reliability and accuracy of these tests, and their inability to predict who will benefit from GH therapy. We recommend that GH stimulation tests no longer routinely be used for the diagnosis of GHD in children.
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Affiliation(s)
- Laura M Gandrud
- Division of Pediatric Endocrinology and Diabetes, Stanford University Medical Center, S-302, Stanford University, Stanford, CA 94305-5208, USA.
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31
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Affiliation(s)
- Anders Juul
- Department of Growth and Reproduction, University of Copenhagen, Blegdamsvej 9 Rigshopitalet, Section 5064, Copenhagen 2100, Denmark.
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32
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Ranke MB, Osterziel KJ, Schweizer R, Schuett B, Weber K, Röbbel P, Vornwald A, Blumenstock G, Elmlinger MW. Reference Levels of Insulin-Like Growth Factor I in the Serum of Healthy Adults: Comparison of Four Immunoassays. Clin Chem Lab Med 2003; 41:1329-34. [PMID: 14580161 DOI: 10.1515/cclm.2003.203] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The measurement of insulin-like growth factor-I (IGF-I) has become an essential tool for diagnosing growth hormone deficiency and acromegaly, as well as for monitoring the efficacy of treatment in these disorders. The latter aspect gains significance in the light of epidemiological studies which indicate a relationship between IGF-I levels and the incidence of certain malignancies. We aimed to evaluate the performance of widely implemented IGF-I assays by testing four representative, commercially available immunoassays. Thus, four parallel determinations of the IGF-I levels of 427 healthy blood donors aged between 18 and 79 years were conducted. Apart from divergent performance criteria, the assays also differed systematically. These differences were, however, linear and of lower magnitude among the lower ranges. We conclude that despite the wide variance among commercially available IGF-I assays, which principally involve assay-specific normative data, each of the implemented assays was robust and thus an appropriate tool in the diagnostic work-up of growth hormone deficiency in adult life, when IGF-I levels are low.
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Affiliation(s)
- Michael Bernd Ranke
- Paediatric Endocrinology Section, University Children's Hospital, Tuebingen, Germany.
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33
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Yamada M, Anzo M, Hasegawa Y. Evaluation of IGF-I Levels in Subjects whose GH Secretion Status was Judged Mainly by Auxological Data. Clin Pediatr Endocrinol 2003. [DOI: 10.1297/cpe.12.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Makoto Yamada
- Endocrinology, Metabolism and Genetics Unit, Tokyo Metropolitan Kiyose Children's Hospital
| | - Makoto Anzo
- Endocrinology, Metabolism and Genetics Unit, Tokyo Metropolitan Kiyose Children's Hospital
| | - Yukihiro Hasegawa
- Endocrinology, Metabolism and Genetics Unit, Tokyo Metropolitan Kiyose Children's Hospital
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Cianfarani S, Tondinelli T, Spadoni GL, Scirè G, Boemi S, Boscherini B. Height velocity and IGF-I assessment in the diagnosis of childhood onset GH insufficiency: do we still need a second GH stimulation test? Clin Endocrinol (Oxf) 2002; 57:161-7. [PMID: 12153594 DOI: 10.1046/j.1365-2265.2002.01591.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The diagnosis of GH insufficiency (GHI) in childhood is not straightforward. Our aim was to test the sensitivity and specificity of height velocity (HV), IGF-I, IGFBP-3 and GH stimulation tests alone or in combination in the diagnosis of GHI. DESIGN A retrospective review of patients with GHI and idiopathic short stature (ISS) diagnosed in our centre and followed up to the completion of linear growth. PATIENTS Thirty-three GHI children and 56 children with ISS were evaluated. GHI diagnosis was based on fulfilment of anthropometric, endocrine and neuroradiological criteria: stature < or = -2 z-score, delayed bone age (at least 1 year), GH peak response to at least two different provocative tests < 10 micro g/l (20 mU/l), brain MRI positive for hypothalamus-pituitary abnormalities, catch-up growth during the first year of GH replacement therapy > or = 75th centile, peak GH response to a third provocative test after growth completion < 10 micro g/l (20 mU/l). Children with anthropometry resembling that of GHI but with peak GH responses > 10 micro g/l (20 mU/l) were diagnosed as ISS. MEASUREMENTS All subjects underwent standard anthropometry. GH secretory status was assessed by clonidine, arginine and GHRH plus arginine stimulation tests. IGF-I and IGFBP-3 circulating levels were measured by immunoradiometric assay (IRMA). The following cut-off values were chosen to discriminate between GHI and nonGHI short children: HV < 25th centile over the 6-12 months prior to the initiation of GH therapy, peak GH responses < 10 or < 7 micro g/l (< 20 or < 14 mU/l) and IGF-I and IGFBP-3-values < -1.9 z-score. Sensitivity (true positive ratio) and specificity (true negative ratio) were evaluated. RESULTS Taking 10 micro g/l (20 mU/l) as the cut-off value, sensitivity was 100% and specificity 57% for GH provocative tests, whereas taking 7 as the cut-off value, sensitivity was 66% and specificity rose to 78%. Sensitivity was 73% for IGF-I and 30% for IGFBP-3 measurement, whilst specificity was 95% for IGF-I and 98% for IGFBP-3 evaluation. HV assessment revealed a sensitivity of 82% and a specificity of 43%. When HV and IGF-I evaluations were used in combination, sensitivity reached 95% and specificity 96%. When both HV and IGF-I are normal (26% of our subjects) GHI may be ruled out, whereas when both the indices are subnormal (23%) GHI is so highly likely that the child may undergo only one GH provocative test and brain MRI and, thereafter, may begin GH therapy without any further test. In case of discrepancy, when IGF-I is normal and HV < 25th centile (44% of children), due to the relatively low sensitivity of IGF-I assessment and low specificity of HV, the patient should undergo GH tests and brain MRI. Finally, in the rare case of HV > 25th centile and subnormal IGF-I-values (7%), due to the high specificity of IGF-I measurement, the child should undergo one provocative test and brain MRI for the high suspicion of GHI. CONCLUSIONS Our results suggest that a simple assessment of HV and basal IGF-I may exclude or, in association with only one stimulation test, confirm the diagnosis of GH insufficiency in more than half of patients with short stature.
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Affiliation(s)
- Stefano Cianfarani
- 'Rina Balducci' Centre of Paediatric Endocrinology, Tor Vergata University, Rome, Italy.
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35
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Loche S, Bizzarri C, Maghnie M, Faedda A, Tzialla C, Autelli M, Casini MR, Cappa M. Results of early reevaluation of growth hormone secretion in short children with apparent growth hormone deficiency. J Pediatr 2002; 140:445-9. [PMID: 12006959 DOI: 10.1067/mpd.2002.122729] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To test the hypothesis that normalization of the growth hormone (GH) response to stimulation in patients with GH deficiency (GHD) and normal magnetic resonance imaging (MRI) of the hypothalamic-pituitary area might occur earlier than at attainment of final height. STUDY DESIGN Prepubertal children with short stature (21 boys and 12 girls; age, 5.2-10 years), in whom a diagnosis of GHD was based on a GH response <10 microg/L after 2 pharmacologic tests (clonidine, arginine, or insulin hypoglycemia), and normal MRI of the hypothalamic-pituitary area were studied. After 1 to 6 months, all children underwent reevaluation of GH secretion by means of one of the provocative tests previously used. During that time, none of the children received GH therapy or entered puberty. RESULTS A GH response > or =10 microg/L after retesting was found in 28 patients, and a GH response <10 microg/L was found in 5. In 9 patients, the peak GH response at diagnosis was <7 microg/L to both tests used. In 8, the GH response at retesting was > or =10 microg/L and was 9.0 microg/L in the remaining child. CONCLUSIONS We suggest that patients with pathologic GH responses to provocative tests but normal MRI should be reevaluated and followed up before a diagnosis of GHD is firmly established.
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Affiliation(s)
- Sandro Loche
- Servizio di Endocrinologia Pediatrica, Ospedale Regionale per le Microcitemie, Cagliari, Clinica Pediatrica, Servizio Analisi Chimico Cliniche, IRCCS Policlinico San Matteo, Università di Pavia, Italy
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36
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37
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Sizonenko PC, Clayton PE, Cohen P, Hintz RL, Tanaka T, Laron Z. Diagnosis and management of growth hormone deficiency in childhood and adolescence. Part 1: diagnosis of growth hormone deficiency. Growth Horm IGF Res 2001; 11:137-165. [PMID: 11735230 DOI: 10.1054/ghir.2001.0203] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- P C Sizonenko
- Endocrinology and Diabetology Clinic, Department of Pediatrics, Hôpital La Tour, 1217 Meyrin-Geneva, Switzerland.
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38
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Laura Audí M, Antonia Llopis M, Granada L, Hermoso F, del Valle J, Dolores Rodríguez-Arnao M, Bel J, Luzuriaga C, Gallego E, Marín F. Baja sensibilidad del IGF-I, la IGFBP-3 y la GH urinaria en el diagnóstico de la insuficiencia de la hormona del crecimiento en niños y adolescentes varones con talla baja y velocidad de crecimiento disminuida. Med Clin (Barc) 2001. [DOI: 10.1016/s0025-7753(01)71700-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Monson JP, Hindmarsh P. The assessment of growth hormone deficiency in children and adults with particular reference to the transitional period. Clin Endocrinol (Oxf) 2000; 53:545-7. [PMID: 11106913 DOI: 10.1046/j.1365-2265.2000.01043.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J P Monson
- Department of Endocrinology, St Bartholomew's and The Royal London School of Medicine and Dentistry, London, UK.
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40
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Affiliation(s)
- H J Guyda
- Department of Pediatrics, McGill University, and Montreal Children's Hospital - MUHC, Montréal, Québec, Canada H3H 1P3
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