title: Challenges in detecting the abuse of growth hormone in sport.
abstract: BACKGROUND
  Growth hormone (GH) is reputed to be in widespread use in the sporting arena as a performance-enhancing agent and is on the list of banned substances published by the World Anti-Doping Agency. The detection of GH abuse poses many challenges. Unlike many substances of abuse, such as synthetic anabolic steroids, GH is a naturally occurring substance; therefore, demonstration of exogenous administration must rely on detecting concentrations in excess of an established reference interval. The purpose of this review is to discuss the methodologies being developed to detect GH abuse.
  
  
  METHODS
  We undertook a comprehensive search using multiple electronic databases and hand searches of reference lists of articles. The data for this review reflect our academic interests and experience through work on the GH-2000 and GH-2004 projects.
  
  
  RESULTS
  Two approaches have been taken to detect GH abuse. The first is based on assessment of the effect of exogenous GH on pituitary GH isoforms, and the second is based on measurement of markers of GH action. The advantages of each approach and the difficulties encountered with each technique, as well as future concepts in detection, are discussed.
  
  
  CONCLUSIONS
  Although there are substantial challenges for the detection of GH, methodologies now exist to detect GH abuse with reasonable sensitivity and specificity.
authors: Endocrinology & Metabolism Sub-Division, Developmental Origins of Adult Health and Disease Division, School of Medicine, University of Southampton, Southampton, United Kingdom. mchugh@soton.ac.uk
authors: Cathy M
authors: CM
authors: McHugh
authors: Roderick T
authors: RT
authors: Park
authors: Peter H
authors: PH
authors: Sönksen
authors: Richard I G
authors: RI
authors: Holt
mesh_terms: D045930:Anabolic Agents / Q000097:blood; D015415:Biomarkers / Q000097:blood; D004300:Doping in Sports / Q000941:ethics / Q000331:legislation & jurisprudence; D019382:Human Growth Hormone / Q000097:blood*; D006801:Humans; D012016:Reference Values; D015813:Substance Abuse Detection / Q000379:methods / Q000592:standards
chemical_list: D045930:Anabolic Agents; D015415:Biomarkers; D019382:Human Growth Hormone