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2018 ; 18
(1
): 20
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Utility of serum IGF-1 for diagnosis of growth hormone deficiency following
traumatic brain injury and sport-related concussion
#MMPMID29609574
Lithgow K
; Chin A
; Debert CT
; Kline GA
BMC Endocr Disord
2018[Apr]; 18
(1
): 20
PMID29609574
show ga
BACKGROUND: Growth hormone deficiency (GHD) is a potential consequence of
traumatic brain injury (TBI), including sport-related concussion (SRC). GH
stimulation testing is required for definitive diagnosis; however, this is
resource intensive and can be associated with adverse symptoms or risks.
Measurement of serum IGF-1 is more practical and accessible, and pituitary tumour
patients with hypopituitarism and low serum IGF-1 have been shown to have a high
probability of GHD. We aimed to evaluate IGF-1 measurement for diagnosing GHD in
our local TBI population. METHODS: We conducted a retrospective chart review of
patients evaluated for GHD at the TBI clinic and referred for GH stimulation
testing with insulin tolerance test (ITT) or glucagon stimulation test (GST)
since December 2013. We obtained demographics, TBI severity, IGF-1, data
pertaining to pituitary function, and GH stimulation results. IGF-1 values were
used to calculate z-scores per age and gender specific reference ranges. Receiver
operator curve analysis was performed to evaluate diagnostic threshold of IGF-1
z-score for determining GHD by GST or ITT. RESULTS: Sixty four patient charts
were reviewed. 48 patients had mild, six had moderate, eight had severe TBI, and
two had non-traumatic brain injuries. 47 patients underwent ITT or GST. 27 were
confirmed to have GHD (peak hGH?5 ?g/L). IGF-1 level was within the age and
gender specific reference range for all patients with confirmed GHD following GH
stimulation testing. Only one patient had a baseline IGF-1 level below the age
and gender specific reference range; this patient had a normal response to GH
stimulation testing. ROC analysis showed IGF-1 z-score AUC f, confirming lack of
diagnostic utility. CONCLUSION: Baseline IGF-1 is not a useful predictor of GHD
in our local TBI population, and therefore has no value as a screening tool. TBI
patients undergoing pituitary evaluation will require a dynamic test of GH
reserve.