Diagnostic strategy for growth hormone deficiency: relevance of IGF-1 determination as a screening test |
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Authors: | Hadjadj S Faure-Gerard C Ragot S Millet C Duengler F Torremocha F Chatellier G Bataille B Marechaud R |
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Institution: | Endocrinology, Diabetology, CHU de Poitiers, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France. s.hadjadj@chu-poitiers.fr |
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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. |
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Keywords: | IGF-1 GH Insuffisance somatotrope de l'adulte Stratégie diagnostique Courbe ROC |
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