title: Diagnosis of endocrine disease: limitations of the IGF1 generation test in children with short stature.
abstract: The IGF1 generation test (IGFGT) is often used during the assessment of suspected GH insensitivity (GHI). We report the results of a survey undertaken in 2010 to determine the use of IGFGT amongst members of the European Society for Paediatric Endocrinology to evaluate suspected GHI. The literature surrounding the usefulness and limitations of IGFGT are reviewed, and recommendations provided for its use. Of 112 paediatric endocrinologists from 30 countries who responded to the survey, 91 (81%) reported that they had used the IGFGT in the previous 2 years; >10 IGFGT protocols were used. The IGFGT impacted treatment decisions for 97% of the respondents and was a prerequisite for recombinant human IGF1 treatment for 45% of respondents. From a literature review, sensitivity of the IGFGT was evaluated as 77-91% in molecularly proven cases of GHI; specificity was ≤97%, depending on the protocol. The positive predictive value of the IGFGT is likely to be low, as the frequency of normality is predictably higher than that of abnormality in GH signalling. Given the limitations of the IGFGT in the most severe cases of GHI syndrome (GHIS), the ability of the IGFGT to detect less severe GHIS is doubtful. In a pragmatic approach, the IGFGT may not be useful for the diagnosis of GHIS.
authors: Endocrinologie Diabétologie Pédiatrique, Pôle Enfant, CHU Angers, 4 rue Larrey, 49933 Angers, Cedex 9, France.
authors: Régis
authors: R
authors: Coutant
authors: Helmuth-Günther
authors: HG
authors: Dörr
authors: Helena
authors: H
authors: Gleeson
authors: Jesús
authors: J
authors: Argente
mesh_terms: D001827:Body Height / Q000502:physiology; D002648:Child; D006130:Growth Disorders / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D013006:Growth Hormone / Q000097:blood / Q000502:physiology*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000096:biosynthesis* / Q000502:physiology; D046150:Laron Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index
chemical_list: D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone