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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Ed. by Bereket, Abdullah / Darendeliler, Feyza / Dattani, Mehul / Gustafsson, Jan / Luo, Fei Hong / Mericq, Veronica / Toppari, Jorma


IMPACT FACTOR 2018: 1.239

CiteScore 2018: 1.22

SCImago Journal Rank (SJR) 2018: 0.507
Source Normalized Impact per Paper (SNIP) 2018: 0.562

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2191-0251
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Volume 32, Issue 2

Issues

IGF-1 assessed by pubertal status has the best positive predictive power for GH deficiency diagnosis in peripubertal children

Thais H. Inoue-Lima
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
  • Other articles by this author:
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/ Gabriela A. Vasques
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
  • Unidade de Endocrinologia Genetica (LIM/25), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
  • Other articles by this author:
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/ Renata C. Scalco
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
  • Unidade de Endocrinologia Genetica (LIM/25), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marilena Nakaguma
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
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  • De Gruyter OnlineGoogle Scholar
/ Berenice B. Mendonca
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
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  • De Gruyter OnlineGoogle Scholar
/ Ivo J.P. Arnhold
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil
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/ Alexander A.L. Jorge
  • Corresponding author
  • Unidade de Endocrinologia Genetica (LIM/25), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Faculdade de Medicina da USP (LIM-25), Av. Dr. Arnaldo, 455 5° andar sala 5340, CEP 01246-903 Sao Paulo, SP, Brazil
  • Unidade de Endocrinologia do Desenvolvimento (LIM/42), Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo (USP), Sao Paulo, Brazil, Phone/Fax: +55-11-3061-7252
  • Email
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Published Online: 2019-01-24 | DOI: https://doi.org/10.1515/jpem-2018-0435

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.

This article offers supplementary material which is provided at the end of the article.

Keywords: diagnosis; evaluation; GH deficiency; IGF-1; positive predictive value; short stature; test performance

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About the article

Received: 2018-10-08

Accepted: 2018-11-20

Published Online: 2019-01-24

Published in Print: 2019-02-25


Funding Source: Fundação de Amparo à Pesquisa do Estado de São Paulo

Award identifier / Grant number: 2013/03236–5

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.


Citation Information: Journal of Pediatric Endocrinology and Metabolism, Volume 32, Issue 2, Pages 173–179, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: https://doi.org/10.1515/jpem-2018-0435.

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