The usefulness of serum IGF-1 and serum IGFBP-3 for the diagnosis of growth hormone deficiency in comparison to clonidine stimulation test: a prospective cohort study

Authors

  • Hemlin Thomas C. Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Sanjeev Kumar Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Bisto A. A. Department of Paediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20210123

Keywords:

Growth hormone deficiency, IGF-1, IGFBP-3, Short stature

Abstract

Background: Growth Hormone Deficiency is conventionally diagnosed by low peak Growth Hormone levels to provocative testing. Serum IGF-1 and IGFBP-3 are under the influence of GH and reflect the endogenous GH secretion. Owing to the absence of a circadian rhythm, it is possible to take individual measurements of IGF-1 and IGFBP-3 at any time of the day for evaluation of GH status instead of subjecting the individual to cumbersome provocative tests. Objectives of this study were to compare IGF-1 and IGFBP-3 assays with clonidine stimulation test in children of different age group with short stature.

Methods: 90 children with short stature were included in the study. Samples for basal GH, IGF-1 and IGFBP-3 were obtained and afterwards all children were subjected to clonidine stimulation test. The diagnostic value of the tests were analysed in terms of sensitivity, specificity, predictive value and accuracy in younger and older age groups.

Results: 40% of the study population was diagnosed to have GHD. IGF-1 had high sensitivity in both age groups. But in the younger age group IGFBP-3 was more specific. Both the tests had same specificity in the older age group. Combining the two tests helped to improve diagnostic value in all the age groups.

Conclusions: Measurements of IGF-1 and IGFBP-3 have shown comparable diagnostic performance with growth hormone stimulation tests and are valuable for patient`s convenience and ease of performance and can be useful in the workup of growth hormone deficiency.

References

Sultan M, Afzal M, Qureshi SM, Aziz S, Lutfullah M, Khan SA, et al. Etiology of short stature in children. J Coll Physicians Surg Pak. 2008;18(8):493-7.

Reiter EO RR. Williams Textbook of Endocrinology. 10th ed. PR Larsen HK, KS Polonsky, editor. Philadelphia: Saunders; 2003.

Waheed K, Irfan K, Ahmad T, Khan H. Spectrum of clinical presentation of chronic renal failure in children. Pak Paediatr J. 2002;26:167-71.

Wallis M. Mechanism of action of growth hormone. New comprehensive Biochemistry. 1988;18:265-94.

Hamilton J, Blaser S, Daneman D. MR imaging in idiopathic growth hormone deficiency. American J of neuroradiology. 1998;19(9):1609-15.

Boisclair Y, Rhoads R, Ueki I, Wang J, Ooi G. The acid-labile subunit (ALS) of the 150 kDa IGF-binding protein complex: An important but forgotten component of the circulating IGF system. J of Endocrinology. 2001;170(1):63-70.

Blum WF, Albertsson-Wikland K, Rosberg S, Ranke MB. Serum levels of insulin-like growth factor I (IGF-I) and IGF binding protein 3 reflect spontaneous growth hormone secretion. J Clin Endocrinol Metabolism. 1993;76(6):1610-6.

Society GR. Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: Summary statement of the GH Research Society. J Clin Endocrinol Metab. 2000;85(11):3990-3.

Wyatt DT, Mark D, Slyper A. Survey of growth hormone treatment practices by 251 pediatric endocrinologists. J Clin Endocrinol Metab. 1995;80(11):3292-7.

Juul A, Skakkebak NE. Prediction of the outcome of growth hormone provocative testing in short children by measurement of serum levels of insulin-like growth factor I and insulin-like growth factor binding protein 3. J Pediatr. 1997;130(2):197-204.

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? Clinical Endocrinology. 2002;57(2):161-7.

Rosenfeld RG. Biochemical diagnostic strategies in the evaluation of short stature: the diagnosis of insulin-like growth factor deficiency. Hormone Res Paediatrics. 1996;46(4-5):170-3.

Kerrigan JR, Rogol AD. The impact of gonadal steroid hormone action on growth hormone secretion during childhood and adolescence. Endocrine Rev. 1992;13(2):281-98.

Cohen P, Rogol A, Deal C, Saenger P, Reiter E, Ross J. Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Res Society, the Lawson Wilkins Pediatric Endocrine Society, and the European society for Paediatric Endocrinology workshop. J Clin Endocrinol Metab. 2008;93(11):4210-7.

Juul A, Kastrup KW, Pedersen SA, Skakkebæk NE. Growth Hormone (GH) provocative retesting of 108 young adults with childhood-onset GH deficiency and the diagnostic value of insulin-like growth factor I(IGF-I) and IGF-binding protein-3 1. J Clin Endocrinol Metab. 1997;82(4):1195-201.

Ranke MB, Schweizer R, Lindberg A, Price DA, Reiter EO, Albertsson-Wikland K. Insulin-like growth factors as diagnostic tools in growth hormone deficiency during childhood and adolescence: the KIGS experience. Hormone Res Paediatr. 2004;62:17-25.

Granada ML, Murillo J, Lucas A, Salinas I, Lopis MA, Castells I. Diagnostic efficiency of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: Importance of an appropriate reference population. Eur J Endocrinol. 2000;142:243-53.

Hasegawa Y, Hasegawa T, Aso T, Kotoh S, Tsuchiya Y, Nose O. Usefulness and limitation of measurement of insulin-like growth factor binding protein-3 (IGFBP-3) for diagnosis of growth hormone deficiency. Endocrinologia Japonica. 1992;39(6):585-91.

Cianfarani S, Liguori A, Boemi S, Maghnie M, Iughetti L, Wasniewska M. Inaccuracy of insulin-like growth factor (IGF) binding protein (IGFBP)-3 assessment in the diagnosis of growth hormone (GH) deficiency from childhood to young adulthood: association to low GH dependency of IGF-II and presence of circulating IGFBP-3 18-kilodalton fragment. J Clin Endocrinol Metab. 2005;90(11):6028-34.

Mitchell M, Sawin C. Growth hormone response to glucagon in diabetic and nondiabetic persons. Israel J Med Sci. 1972;8(6):867.

Downloads

Published

2021-01-22

Issue

Section

Original Research Articles