Abstract
Background
When evaluating peripubertal short stature patients, the interpretation of insulin-like growth factor 1 (IGF-1) levels based on chronological age (CA) can be inaccurate due to the influence of sex steroids and, presently, there is no evidence to support the assessment of IGF-1 values according to bone age (BA) and pubertal status (PS). Our objective was to assess the discriminatory performance of IGF-1 levels based on CA, BA and PS in the diagnosis of growth hormone (GH) deficiency.
Methods
We evaluated IGF-1 levels from 154 peripubertal short stature patients classified as GH deficient (GHD, n=23) or non-GHD (n=131). IGF-1 was assayed by a chemiluminescent immunometric assay and transformed into standard deviation scores (SDS) according to CA (IGF-1-SDS-CA), BA (IGF-1-SDS-BA) and PS (IGF-1-SDS-PS).
Results
The performances of IGF-1-SDS-CA, IGF-1-SDS-BA and IGF-1-SDS-PS in the receiver operator characteristics (ROC) curves were similar. There were greater accuracy and specificity of IGF-1-SDS-PS (98.4% and 93.3%, respectively) and IGF-1-SDS-BA (92.7% and 90.1%, respectively) when compared to IGF-1-SDS-CA (65.6% and 69.5%, respectively). The post-test probability of the IGF-1-SDS was also improved when compared to PS and BA – 44.8% (IGF-1-SDS-PS), 16.8% (IGF-1-SDS-BA) and 5.1% (IGF-1-SDS-CA), with similar negative predictive values.
Conclusions
The evaluation of IGF-1 levels based on CA has a higher sensitivity than those based on BA or PS, which justify its use as a screening tool. Additionally, IGF-1 assessed by PS has the best positive predictive power for GHD diagnosis in peripubertal age and could reduce the necessity of a second GH stimulation test.
Funding source: Fundação de Amparo à Pesquisa do Estado de São Paulo
Award Identifier / Grant number: 2013/03236–5
Funding statement: This work was supported by the São Paulo Research Foundation (FAPESP) Funder id: 10.13039/501100001807, Grant number 2013/03236–5 (to A.A.L.J.) and the National Council of Technological and Scientific Development – Brazil: Funder id: 10.13039/501100003593, Grant number CNPq-PQ 301871/2016-7 (to A.A.L.J.), Grant number CNPq-PQ 305743/2011-2 (to B.B.M.) and Grant number CNPq-PQ 307922/2013-8 (to I.J.P.A.).
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Employment or leadership: None declared.
Honorarium: None declared.
Disclosure summary: The authors declare there is no conflict of interest that could be perceived as influencing the impartiality of the research reported.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpem-2018-0435).
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