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Archives of Disease in Childhood 1999;80:443-447; doi:10.1136/adc.80.5.443
Copyright © 1999 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child 1999;80:443-447 ( May )

Failure of IGF-I and IGFBP-3 to diagnose growth hormone insufficiency

H Mitchell, M T Dattani, V Nanduri, P C Hindmarsh, M A Preece, C G D Brook

London Centre for Paediatric Endocrinology, Great Ormond Street and The Middlesex Hospitals, London W1H 8AA, UK

Correspondence to: Professor C G D Brook, Cobbold Laboratories, The Middlesex Hospital, Mortimer Street, London W1A 8AA, UK. email: c.brook{at}ucl.ac.uk

Accepted 27 January 1999

BACKGROUND---Growth hormone insufficiency (GHI) is diagnosed conventionally by short stature and slow growth, and is confirmed by diminished peak GH response to a provocation test. Insulin-like growth factor I (IGF-I) and IGF binding protein 3 (IGFBP-3) have previously been considered individually
OBJECTIVE---To test the hypothesis that the combined analysis of IGF-I and IGFBP-3 could act as a surrogate marker for the diagnosis of GHI.
DESIGN---Reference ranges for IGF-I and IGFBP-3 were calculated using 521 normal individuals. A retrospective analysis was performed on 318 children referred for investigation of short stature.
RESULTS---No significant difference was found between either the IGF-I or IGFBP-3 standard deviation scores (SDSs) in children with and without GHI. If the requirement were for both tests to be positive (< -2 SDS) for a diagnosis of GHI, then 99% of children without GHI would be correctly identified; however, the sensitivity of the test was only 15%.
CONCLUSIONS---Neither IGF-I nor IGFBP-3 alone is a marker for GHI. In addition, they cannot be used as an effective screening test in combination.


Keywords: insulin-like growth factor I; insulin-like growth factor binding protein 3; growth hormone insufficiency

© 1999 by Archives of Disease in Childhood
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