What question did this study set out to answer?

To compare the diagnostic accuracy of urinary GH excretion, serum IGF-I, and serum IGFBP-3 with standard GH stimulation tests in children clinically diagnosed with growth hormone deficiency.

February 1, 1997The Journal of Clinical Endocrinology & Metabolism

Biochemical Tests in the Diagnosis of Childhood Growth Hormone Deficiency*

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Why the study?

Do urinary GH, serum IGF-I, and IGFBP-3 levels provide better diagnostic accuracy than GH stimulation tests for childhood growth hormone deficiency?

Population

170 children, comprising Group I with clinically defined growth hormone deficiency based on medical history…

Comparison

Measurement of urinary GH excretion, serum… vs GH stimulation tests

Design

Cross-sectional

Authors

VTVallo TillmannUniversity of Tartu JBJohn BucklerLeeds General Infirmary MKMohammed KibirigeJames Cook University Hospital

Discussion

Member takes

Implication

GH stimulation testing remains key to exclude childhood GHD; leaves open whether IGF-I/IGFBP-3 add value in combined algorithms.

Key Points

To compare the diagnostic accuracy of urinary GH excretion, serum IGF-I, and serum IGFBP-3 with standard GH stimulation tests in children clinically diagnosed with growth hormone deficiency.
Evaluated 60 children with clinically defined growth hormone deficiency (Group I, mean age 10.3 ± 4.8 years) and 110 short children without suspected deficiency (Group II, mean age 9.8 ± 4.0 years).
Measured GH stimulation test peaks, 24-hour urinary GH excretion, serum IGF-I, and serum IGFBP-3 standard deviation scores.
Developed a diagnostic scoring system based on positive predictive values derived from combined biochemical measurements.
A single GH stimulation test achieved a sensitivity of 85% at a 10 ng/mL cutoff and a specificity of 92% at 5 ng/mL, whereas cutoffs of -2 SD for IGF-I, IGFBP-3, and urinary GH yielded poor sensitivities of 34%, 22%, and 25%, with specificities of 72%, 92%, and 76%, respectively.
Normal IGFBP-3 failed to exclude growth hormone deficiency in specific subgroups, with only 2 of 21 pubertal children and 0 of 27 radiation-induced deficiency cases showing an IGFBP-3 score below -1.5 SD.
A multivariable score of 10 or higher provided 94% specificity with 34% sensitivity, and a peak stimulated GH concentration exceeding 10 ng/mL served as the single most effective investigation to exclude deficiency.

Structured PICO

Do urinary GH, serum IGF-I, and IGFBP-3 levels provide better diagnostic accuracy than GH stimulation tests for childhood growth hormone deficiency?

Population

170 children, comprising Group I (n=60, mean age 10.3 +/- 4.8 years) with clinically defined growth hormone deficiency (GHD) based on medical history of pituitary dysfunction or typical phenotypic features, and Group II (n=110, mean age 9.8 +/- 4 years) comprising short children in whom GHD was not suspected but needed exclusion.

Intervention

Measurement of urinary GH excretion, serum insulin-like growth factor I (IGF-I), and IGF-binding protein-3 (IGFBP-3) levels

Comparator

GH stimulation tests

Outcome

Diagnostic sensitivity and specificity for identifying clinically defined growth hormone deficiencysurrogate

Serum IGF-I, IGFBP-3, and urinary GH levels have poor sensitivity for diagnosing childhood growth hormone deficiency compared to traditional GH stimulation tests.

Cite This Study

Tillmann et al. (1997) studied this question.

synapsesocial.com/papers/6a961eb2f83cd384059912e9 https://doi.org/10.1210/jcem.82.2.3750

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Biochemical Tests in the Diagnosis of Childhood Growth Hormone Deficiency*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Biochemical Tests in the Diagnosis of Childhood Growth Hormone Deficiency*

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider