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Lotierzo M, Olaru-Soare F, Dupuy AM, Plawecki M, Paris F, Cristol JP. Comparative study of human growth hormone measurements: impact on clinical interpretation. Clin Chem Lab Med 2021; 60:191-197. [PMID: 34850616 DOI: 10.1515/cclm-2021-1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Human growth hormone (hGH) provocation test is an essential tool to assess growth hormone deficiency (GHD) in children and young adults. It is important to have a robust method to determine the hGH peak of stimulation. This work aimed to compare three common automated immunoassays for hGH quantification and to ascertain whether there are still result-related differences which can impact clinical decision. METHODS We analyzed the GH provocation test for 39 young subjects from pediatric department of Montpellier hospital, admitted for suspicion of growth hormone deficiency. The full range of measurements as well as the peak level of serum GH were compared using three automated immunoassays on three different immunoanalyzers: IDS-hGH on iSYS, LIAISON-hGH on Liaison XL and Elecsys ROCHE-hGH, on COBAS 8000. RESULTS A good correlation was obtained between methods for all measurements (r 2>0.99) by using Passing-Bablok regression analysis. Bland-Altman analysis showed the best agreement between IDS-hGH and LIAISON-hGH systems (bias=-14.5%) compared to Elecsys ROCHE-hGH (bias=28.3%). When considering stratification of the study population and a unique cutoff, there were some discrepancies in interpretation of the results especially concerning the more recent Elecsys ROCHE-hGH assay. Nevertheless, when the adequate cutoff for each method was taken into account results were well correlated for all systems. CONCLUSIONS A cutoff for Elecsys Roche-hGH method was established to better explain the results. Clinician must be aware of the use of assay-specific cutoff to correctly integrate the results of GH tests in the GHD diagnosis.
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Affiliation(s)
- Manuela Lotierzo
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France.,Département de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France
| | - Florin Olaru-Soare
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France
| | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France
| | - Maëlle Plawecki
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France.,Département de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France
| | - Françoise Paris
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France.,Département de Pédiatrie, Unité d'Endocrinologie-Gynécologie Pédiatrique, Hôpital A.-de-Villeneuve, CHU Montpellier et Université Montpellier, Montpellier, France
| | - Jean-Paul Cristol
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France.,Département de Biochimie et Hormonologie, PhyMedExp, Université de Montpellier, INSERM, CNRS, Centre de Ressources Biologiques, CHU de Montpellier, Montpellier, France
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Murray PG, Dattani MT, Clayton PE. Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence. Arch Dis Child 2016; 101:96-100. [PMID: 26153506 DOI: 10.1136/archdischild-2014-307228] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/15/2015] [Indexed: 11/04/2022]
Abstract
Growth hormone deficiency (GHD) is a rare but important cause of short stature in childhood with a prevalence of 1 in 4000. The diagnosis is currently based on an assessment of auxology along with supporting evidence from biochemical and neuroradiological studies. There are significant controversies in the diagnosis and management of GHD. Growth hormone (GH) stimulation tests continue to play a key role in GHD diagnosis but the measured GH concentration can vary significantly with stimulation test and GH assay used, creating difficulties for diagnostic accuracy. Such issues along with the use of adjunct biochemical markers such as IGF-I and IGFBP-3 for the diagnosis of GHD, will be discussed in this review. Additionally, the treatment of GHD remains a source of much debate; there is no consensus on the best mechanism for determining the starting dose of GH in patients with GHD. Weight and prediction based models will be discussed along with different mechanisms for dose adjustment during treatment (auxology or IGF-I targeting approaches). At the end of growth and childhood treatment, many subjects diagnosed with isolated GHD re-test normal. It is not clear if this represents a form of transient GHD or a false positive diagnosis during childhood. Given the difficulties inherent in the diagnosis of GHD, an early reassessment of the diagnosis in those who respond poorly to GH is to be recommended.
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Affiliation(s)
- P G Murray
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester Foundation Hospitals NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M T Dattani
- Section of Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK London Centre for Paediatric Endocrinology and Diabetes, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - P E Clayton
- Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester Foundation Hospitals NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
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Manolopoulou J, Alami Y, Petersenn S, Schopohl J, Wu Z, Strasburger CJ, Bidlingmaier M. Automated 22-kD growth hormone-specific assay without interference from Pegvisomant. Clin Chem 2012; 58:1446-56. [PMID: 22908135 DOI: 10.1373/clinchem.2012.188128] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Large variability exists among different growth hormone (GH) assays owing to differences in calibration, antibody specificity, isoform recognition, and interference from GH binding protein (GHBP). The GH receptor antagonist Pegvisomant presents a new challenge because Pegvisomant interferes with many GH assays. A recent consensus conference established criteria for standardization and evaluation of GH assays. Following consensus recommendations, we developed a new GH assay on an automated analyzer (IDS-iSYS, Immunodiagnostic Systems). METHODS A monoclonal antibody not cross-reacting with Pegvisomant was combined with a monoclonal antibody specific for 22-kD GH. Isoform specificity and interference from GHBP was tested and compared to that seen in 2 existing automated GH assays (Siemens Immulite, Diasorin Liaison). We also compared GH concentrations measured by the 3 assays for healthy volunteers and patients with acromegaly receiving different treatments. Using the iSYS assay, we also established nadir GH values during oral glucose load and analyzed changes in endogenous GH during Pegvisomant treatment. RESULTS Analytical and functional sensitivities were 0.01 μg/L and 0.04 μg/L, with a dynamic range from 0.04 to 100 μg/L. Intraassay CVs were 2%-4%, whereas interassay CVs were 5%-7% at GH concentrations between 1.7 and 27.5 μg/L. The assay was specific for 22-kD GH and not affected by GHBP. The presence of Pegvisomant, which leads to a negative bias on the Immulite and dramatic overestimation of GH on the Liaison, had no impact on the iSYS GH assay. CONCLUSIONS The new assay fulfils recent consensus recommendations and presents a useful new tool for reliable measurement of GH.
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Affiliation(s)
- Jenny Manolopoulou
- Endocrine Research Laboratories, Medizinische Klinik und Poliklinik IV, Ludwig Maximilians University, Munich, Germany
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Bidlingmaier M, Freda PU. Measurement of human growth hormone by immunoassays: current status, unsolved problems and clinical consequences. Growth Horm IGF Res 2010; 20:19-25. [PMID: 19818659 PMCID: PMC7748084 DOI: 10.1016/j.ghir.2009.09.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 09/17/2009] [Indexed: 01/28/2023]
Abstract
Measuring the concentration of growth hormone (GH) in blood samples taken during dynamic tests represents the basis for diagnosis of growth hormone related disorders, namely growth hormone deficiency and growth hormone excess. Today, a wide spectrum of immunoassays are in use, enabling rapid and sensitive determination of growth hormone concentrations in routine diagnostics. From a clinical point of view several difficulties exist with the use and interpretation of GH assay results in the assessment of GH related disorders: Many physiological factors such as fat mass, age and gender influence the outcome of dynamic tests, overall leading to significant inter-individual differences in GH responses. However, in addition to the physiological variability, considerable variability exists in GH assay results obtained by different immunoassays. Unfortunately, all the new technical advances in the field of GH measurement techniques have not reduced this methodological variability. To a large extent, the actual values reported for the GH concentration in a sample depend on the method used by the respective laboratory. Obviously, such discrepancies limit the applicability of consensus guidelines on diagnosis and treatment in clinical practice. This review summarizes current practices for GH measurement with respect to the methods used, their limitations and the clinical consequences of the existing heterogeneity in GH immunoassay results.
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Affiliation(s)
- Martin Bidlingmaier
- Endocrine Research Laboratories, Medizinische Klinik - Innenstadt, Ludwig-Maximilians University, Munich, Germany.
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Zadik Z. Laboratory diagnosis of growth hormone deficiency (GHD). J Pediatr Endocrinol Metab 2009; 22:1-2. [PMID: 19344067 DOI: 10.1515/jpem.2009.22.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bidlingmaier M, Strasburger CJ. What endocrinologists should know about growth hormone measurements. Endocrinol Metab Clin North Am 2007; 36:101-8. [PMID: 17336737 DOI: 10.1016/j.ecl.2006.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Determination of human growth hormone (GH) concentration in serum plays a key role in the diagnosis of GH deficiency and GH excess (acromegaly). Methods of measuring GH still lack standardization and show considerable between-method variability. Therefore, correct interpretation of GH test results requires knowledge of measurement techniques and awareness of potential problems in applying recommendations for cut-off values given in the literature. This article focuses on the molecular, structural, and methodologic background of the heterogeneity of assay results and on possible next steps toward standardization.
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Affiliation(s)
- Martin Bidlingmaier
- Endocrine Research Laboratories, Medizinische Klinik-Innenstadt, Ludwig-Maximilians University, Ziemssenstrasse 1, Munich 80336, Germany.
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Delvin EE, Laxmi Grey V, Vergee Z. Gap analysis of pediatric reference intervals related to thyroid hormones and the growth hormone–insulin growth factor axis. Clin Biochem 2006; 39:588-94. [PMID: 16762334 DOI: 10.1016/j.clinbiochem.2006.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2005] [Revised: 02/27/2006] [Accepted: 03/12/2006] [Indexed: 11/22/2022]
Abstract
Efficacy of laboratory medicine in assisting attending physicians in their diagnostic and follow-up endeavors is intimately linked to an access to meaningful and reliable reference values. Pediatrics is particularly sensitive to this problem as the processes, associated with growth and development, are imposing rapid discontinuous changes on the physiology of the individuals. Some developmental stages are more critical than others. The neonatal and the pubertal periods, for which we lack reference ranges, are two such examples. Beyond biological considerations, we realize that, over the last 2 decades, technology has evolved, both at the analytical and reagent levels. This technological evolution inexorably leads to the need in redefining reference values. It is for this reason that a group of clinical and medical biochemists have joined their efforts in creating the Canadian Laboratory Initiative in Paediatric Reference (CALIPER) which objective is to define a pan-Canadian set of reference values from birth to late adolescence. To illustrate the need of such a venture, a brief gap analysis for biochemical variables related to the thyroid function, and the growth hormone-insulin-like growth factors axis follows.
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Affiliation(s)
- Edgard E Delvin
- Department of Clinical Biochemistry, CHU Sainte-Justine, Université de Montréal, 3175 Côte Ste-Catherine, Montréal, Québec, Canada H3T 1C5.
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Popii V, Baumann G. Laboratory measurement of growth hormone. Clin Chim Acta 2004; 350:1-16. [PMID: 15530455 DOI: 10.1016/j.cccn.2004.06.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 06/04/2004] [Accepted: 06/07/2004] [Indexed: 11/24/2022]
Abstract
Growth hormone (GH) measurements are complicated by the heterogeneous nature of GH, as well as by the presence of the GH binding protein in plasma. Several isoforms of GH exist, and specific assays for each are currently either unavailable, impractical, or not clinically indicated. Bioassays include the in vivo assays based on rat weight gain, tibial line widening, or IGF-I generation. In vitro bioassays, based on the proliferation of cell lines expressing the prolactin receptor or GH receptor, are sensitive but prone to nonspecific interference by factors present in serum. Immunoassays (RIA, IRMA, ELISA, and immunofunctional assay design) are widely used in the clinical laboratory because of speed, sensitivity, and convenience. Discrepancies among results rendered by different immunoassays have become more apparent as monoclonal assays have superseded polyclonal assays, presumably because different antibodies recognize different epitopes among the heterogeneous mixture of GH isoforms in serum. Some assays, especially those with short, nonequilibrium incubation times are vulnerable to interference by the GH binding protein present in serum. Recommendations are given for strategies designed to minimize disparity of results obtained by different GH immunoassays applied to serum. Urinary GH measurements, while technically feasible, are of limited clinical utility because of biological variation in urinary GH excretion.
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Affiliation(s)
- Violeta Popii
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine and Veterans Administration Chicago Health Care System, 303 East Chicago Avenue, Chicago, Illinois 60611, USA
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Abstract
The unfolding of pubertal growth and maturation entails multisystem collaboration. Most notably, the outflow of gonadotropins and growth hormone (GH) proceeds both independently and jointly. The current update highlights this unique dependency in the human.
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