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

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art_INOUE-LIMA_IGF1_assessed_by_pubertal_status_has_the_best_2019.PDF (187.5 KB)
Citações na Scopus
23
Tipo de produção
article
Data de publicação
2019
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
WALTER DE GRUYTER GMBH
Autores
Citação
JOURNAL OF PEDIATRIC ENDOCRINOLOGY & METABOLISM, v.32, n.2, p.173-179, 2019
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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 (IGF1-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 (98A% 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 Gil stimulation test.
Palavras-chave
diagnosis, evaluation, GH deficiency, IGF-1, positive predictive value, short stature, test performance
URI
https://observatorio.fm.usp.br/handle/OPI/31094
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MCM
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/25
Artigos e Materiais de Revistas Científicas - LIM/42