Establishment of reference values for endocrine tests. Part VII: growth hormone deficiency.
BACKGROUND
Plasma insulin-like growth factor (IGF-I) concentration can be used as a rough indicator of the growth-hormone status. However, for the diagnosis of growth hormone deficiency, dynamic tests are required. The growth hormone (GH) response in the insulin tolerance test (ITT) is considered to be the gold standard in this respect. An alternative for the ITT is the GHRH/ GHRP-6 test, which has fewer side effects. In this study we established reference values for IGF-I levels and for the GH response in both dynamic tests.


METHODS
We studied 296 subjects recruited from the general population, equally distributed according to sex and aged between 20 and 70 years. Serum IGF-I level was measured in all subjects and an insulin tolerance test (0.15 U/kg Actrapid iv) and GHRH/GHRP-6 test (1 microg GHRH/kg and 1 microg GHRP-6/kg) were performed in 49 subjects.


RESULTS
In multivariate analyses both IGF-I and the GH response in the ITT were significantly influenced by age, whereas the GH response in the GHRH/GHRP-6 test was significantly affected by BMI. There was no sex difference in IGF-I and in the GHRH/GHRP-6 test, but in the ITT males had a higher GH peak. There was a significant correlation between the GH responses in both tests, and the GH response was significantly higher in the GHRH/GHRP-6 test than in the ITT. Age-adjusted reference values were established for each test.


CONCLUSIONS
We have established age-adjusted reference values for serum IGF-I and for the GH response in the ITT and GHRH/GHRP-6 test.
Eskes
S A
SA
Department of Endocrinology and Metabolism, Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands. s.a.eskes@amc.uva.nl
Tomasoa
N B
NB
Endert
E
E
Geskus
R B
RB
Fliers
E
E
Wiersinga
W M
WM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D003940:Diagnostic Techniques, Endocrine; D005260:Female; D005951:Glucose Tolerance Test; D013007:Growth Hormone-Releasing Hormone / Q000097:blood* / Q000592:standards; D019382:Human Growth Hormone / Q000097:blood / Q000172:deficiency* / Q000592:standards; D006801:Humans; D007118:Immunoassay; D007328:Insulin; D007334:Insulin-Like Growth Factor I / Q000032:analysis* / Q000592:standards; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D009842:Oligopeptides / Q000097:blood* / Q000592:standards; D012016:Reference Values; D012044:Regression Analysis; D055815:Young Adult
D007328:Insulin; D009842:Oligopeptides; D019382:Human Growth Hormone; C041048:growth hormone releasing hexapeptide; D007334:Insulin-Like Growth Factor I; D013007:Growth Hormone-Releasing Hormone