| Abstract | BACKGROUND: Adult growth hormone (GH) deficiency must be diagnosed before prescribing therapeutic recombinant human GH. We studied the clinical relevance of a diagnostic strategy for growth hormone deficiency (GHD) using IGF-1 determination as a first step. METHODS: In 2000 and 2001, we tested 142 adult patients with hypothalamo-pituitary disorders for somatotropic function using Insulin Tolerance Test (ITT), the reference test for the diagnosis of GHD, with concomitant Insulin-like growth factor-1 (IGF-1) determination, a marker of somatotropic function. Patients were classified as GHD (peak GH concentration<3 ng/ml with the ITT) or normal. SETTING: Monocenter prospective study in a tertiary referral center. RESULTS: GHD was diagnosed in 61 subjects. Using a ROC curve, a threshold IGF-1 concentration of 175 ng/ml yielded a negative predictive value of 89+/-5%. A diagnostic strategy with IGF-1 determination as the first step followed by ITT for patients with an IGF-1 concentration below 175 ng/ml missed five of the 61 GHD patients, avoided 46/142 ITT and reduced the cost of diagnosis by 15%. CONCLUSION: We propose the use of a strategy consisting of IGF-1 determination followed, if below 175 ng/ml by confirmatory ITT to diagnose GHD in adults. |
| Authors | S Hadjadj, C Faure-Gerard, S Ragot, C Millet, F Duengler, F Torremocha, G Chatellier, B Bataille, R Marechaud
(Affiliation: Endocrinology, Diabetology, CHU de Poitiers, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France. s.hadjadj at chu-poitiers.fr)
|
| Journal | Annales d'endocrinologie
(Ann Endocrinol (Paris))
Vol. 68
Issue 6
Pg. 449-55
(Dec 2007)
ISSN: 0003-4266 France |
| PMID | 17991453
(Publication Type: Journal Article)
|
| Chemical References |
- Biological Markers
- Insulin-Like Growth Factor I
- Growth Hormone
|
| Topics |
- Adult
- Aged
- Biological Markers
(blood)
- False Negative Reactions
- False Positive Reactions
- Female
- Growth Hormone
(deficiency)
- Humans
- Hypothalamic Diseases
(blood, diagnosis)
- Insulin-Like Growth Factor I
(metabolism)
- Male
- Middle Aged
- Pituitary Diseases
(blood, diagnosis)
- Prospective Studies
- Sensitivity and Specificity
|
