Biochemical tests in the diagnosis of childhood growth hormone deficiency.

2.50
Hdl Handle:
http://hdl.handle.net/10541/94693
Title:
Biochemical tests in the diagnosis of childhood growth hormone deficiency.
Authors:
Tillmann, V; Buckler, J M; Kibirige, M S; Price, David A; Shalet, Stephen M; Wales, J K; Addison, M G; Gill, M S; Whatmore, A J; Clayton, Peter E
Abstract:
GH stimulation tests are widely used in the diagnosis of GH deficiency (GHD), although they are associated with a high false positive rate. We have examined, therefore, the performance of other tests of the GH axis [urinary GH excretion, serum insulin-like growth factor I(IGF-I), and IGF-binding protein-3 (IGFBP-3) levels] compared with GH stimulation tests in identifying children defined clinically as GH deficient. Group I comprised 60 children (mean age, 10.3 +/- 4.8 yr) whose diagnosis of GHD was based on a medical history indicative of pituitary dysfunction (n = 43) or on the typical phenotypic features and appropriate auxological characteristics of isolated GHD (n = 17). Group II comprised 110 short children (mean age, 9.8 +/- 4 yr) in whom GHD was not suspected, but needed exclusion. The best sensitivity for a single GH test was 85% at a peak GH cut-off level of 10 ng/mL, whereas the best specificity was 92% at 5 ng/mL. The sensitivities of IGF-I, IGFBP-3, and urinary GH, using a cut-off of -2 SD score were poor at 34%, 22%, and 25%, respectively, with specificities of 72%, 92%, and 76% respectively. Only 2 of 21 pubertal children in group I and none of the 27 subjects with radiation-induced GHD had an IGFBP-3 SD score less than -1.5. We devised a scoring system based on the positive predictive value of each test, incorporating data from the GH test and the IGF-I and IGFBP-3 levels. A specificity of 94% could be achieved with a score of 10 or more (maximum 17) (sensitivity 34%). The latter could not be improved above 81% with a score of 5 points or more (specificity, 69%). A high score was, therefore, highly indicative of GHD, but was achieved by few patients. A normal IGFBP-3 level, however, did not exclude GHD, particularly in patients with radiation-induced GHD and those in puberty. A GH test with a peak level more than 10 ng/mL was the most useful single investigation to exclude a diagnosis of GHD.
Affiliation:
Royal Manchester Children's Hospital, Manchester, United Kingdom.
Citation:
Biochemical tests in the diagnosis of childhood growth hormone deficiency. 1997, 82 (2):531-5 J. Clin. Endocrinol. Metab.
Journal:
Journal of Clinical Endocrinology and Metabolism
Issue Date:
Feb-1997
URI:
http://hdl.handle.net/10541/94693
DOI:
10.1210/jc.82.2.531
PubMed ID:
9024249
Type:
Article
Language:
en
ISSN:
0021-972X
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorTillmann, Ven
dc.contributor.authorBuckler, J Men
dc.contributor.authorKibirige, M Sen
dc.contributor.authorPrice, David Aen
dc.contributor.authorShalet, Stephen Men
dc.contributor.authorWales, J Ken
dc.contributor.authorAddison, M Gen
dc.contributor.authorGill, M Sen
dc.contributor.authorWhatmore, A Jen
dc.contributor.authorClayton, Peter Een
dc.date.accessioned2010-03-23T12:47:10Z-
dc.date.available2010-03-23T12:47:10Z-
dc.date.issued1997-02-
dc.identifier.citationBiochemical tests in the diagnosis of childhood growth hormone deficiency. 1997, 82 (2):531-5 J. Clin. Endocrinol. Metab.en
dc.identifier.issn0021-972X-
dc.identifier.pmid9024249-
dc.identifier.doi10.1210/jc.82.2.531-
dc.identifier.urihttp://hdl.handle.net/10541/94693-
dc.description.abstractGH stimulation tests are widely used in the diagnosis of GH deficiency (GHD), although they are associated with a high false positive rate. We have examined, therefore, the performance of other tests of the GH axis [urinary GH excretion, serum insulin-like growth factor I(IGF-I), and IGF-binding protein-3 (IGFBP-3) levels] compared with GH stimulation tests in identifying children defined clinically as GH deficient. Group I comprised 60 children (mean age, 10.3 +/- 4.8 yr) whose diagnosis of GHD was based on a medical history indicative of pituitary dysfunction (n = 43) or on the typical phenotypic features and appropriate auxological characteristics of isolated GHD (n = 17). Group II comprised 110 short children (mean age, 9.8 +/- 4 yr) in whom GHD was not suspected, but needed exclusion. The best sensitivity for a single GH test was 85% at a peak GH cut-off level of 10 ng/mL, whereas the best specificity was 92% at 5 ng/mL. The sensitivities of IGF-I, IGFBP-3, and urinary GH, using a cut-off of -2 SD score were poor at 34%, 22%, and 25%, respectively, with specificities of 72%, 92%, and 76% respectively. Only 2 of 21 pubertal children in group I and none of the 27 subjects with radiation-induced GHD had an IGFBP-3 SD score less than -1.5. We devised a scoring system based on the positive predictive value of each test, incorporating data from the GH test and the IGF-I and IGFBP-3 levels. A specificity of 94% could be achieved with a score of 10 or more (maximum 17) (sensitivity 34%). The latter could not be improved above 81% with a score of 5 points or more (specificity, 69%). A high score was, therefore, highly indicative of GHD, but was achieved by few patients. A normal IGFBP-3 level, however, did not exclude GHD, particularly in patients with radiation-induced GHD and those in puberty. A GH test with a peak level more than 10 ng/mL was the most useful single investigation to exclude a diagnosis of GHD.en
dc.language.isoenen
dc.subject.meshAdolescent-
dc.subject.meshBiochemistry-
dc.subject.meshChild-
dc.subject.meshFemale-
dc.subject.meshHuman Growth Hormone-
dc.subject.meshHumans-
dc.subject.meshInsulin-Like Growth Factor Binding Protein 3-
dc.subject.meshInsulin-Like Growth Factor I-
dc.subject.meshMale-
dc.subject.meshMetabolism, Inborn Errors-
dc.titleBiochemical tests in the diagnosis of childhood growth hormone deficiency.en
dc.typeArticleen
dc.contributor.departmentRoyal Manchester Children's Hospital, Manchester, United Kingdom.en
dc.identifier.journalJournal of Clinical Endocrinology and Metabolismen

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