title: 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.
abstract: OBJECTIVE
  To analyse the diagnostic role of serum IGF-I, IGF-binding protein-3 (IGFBP-3), IGF-I/IGFBP-3 molar ratio and urinary GH (uGH) excretion in adult GH deficiency (GHD).
  
  
  METHODS
  Twenty-seven adults (age range: 18-71 years) with severe GHD, defined by a peak GH response to an insulin tolerance test below 3microg/l in patients with at least one additional pituitary hypofunction. Reference values were established from a selected age- and body mass index-matched population (154 healthy adults grouped in four age groups).
  
  
  METHODS
  IGF-I and IGFBP-3 were measured by RIA (Nichols) and results expressed as standard deviation (s.d.) scores from our reference population and assay normative data (s.d. score Nichols). uGH was measured by IRMA.
  
  
  RESULTS
  Within the control group, IGF-I, IGFBP-3, IGF-I/IGFBP-3 ratio standardisation regarding our control population and IGF-I with respect to the assay normative data resulted in disappearance of age-related differences. However, IGFBP-3 s.d. score Nichols resulted in mean values between +1.4 and +2.5 s.d. score. Greatest diagnostic efficiency was for IGF-I standardised with respect to our controls (97.2%), followed by s.d. score IGFBP-3 (92.9%). s.d. score IGF/IGFBP-3 ratio and uGH showed poor diagnostic efficiency. Any combination of at least two abnormal parameters raised specificity to 100%. IGF-I standardised with respect to assay reference (s.d. score Nichols) showed similar diagnostic value (95.0%) whereas IGFBP-3 showed low sensitivity (33. 3%). Within the GHD patients, those with three or more additional deficiencies had lower s.d. score IGF-I than those with only two or one.
  
  
  CONCLUSIONS
  We underline the importance of an appropriate reference population for correct interpretation of GH secretion markers. Considering our results, specificity obtained with two simultaneous abnormal parameters when referred to an adequate reference population may add valuable information to alternative GH stimulation tests to confirm adult GHD.
authors.affiliation: Department of Clinical Biochemistry, Hospital Universitari Germans Trias i Pujol, Autonomous University of Barcelona, Badalona, Spain. mgranada@ns.hugtip.scs.es
authors.forename: M L
authors.initials: ML
authors.lastname: Granada
authors.forename: J
authors.initials: J
authors.lastname: Murillo
authors.forename: A
authors.initials: A
authors.lastname: Lucas
authors.forename: I
authors.initials: I
authors.lastname: Salinas
authors.forename: M A
authors.initials: MA
authors.lastname: Llopis
authors.forename: I
authors.initials: I
authors.lastname: Castells
authors.forename: M
authors.initials: M
authors.lastname: Foz
authors.forename: A
authors.initials: A
authors.lastname: Sanmartí
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D013006:Growth Hormone / Q000097:blood / Q000172:deficiency; D019382:Human Growth Hormone / Q000097:blood* / Q000172:deficiency*; D006801:Humans; D007018:Hypopituitarism / Q000097:blood* / Q000175:diagnosis*; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D018972:Insulin-Like Growth Factor Binding Protein 3; D019382:Human Growth Hormone; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone