Diagnosis of Growth Hormone Deficiency: the role of Growth Hormone (GH), Insulin-Like Growth Factor (IGF-I) and IGF-Binding Protein (IGFBP-3)

Despite dramatic changes in the treatment of growth hormone (GH) deficiency from cadaveric pituitary growth hormone to recombinant human growth hormone, the diagnosis of idiopathic growth hormone deficiency remains a challenge for the clinician. The uncertanities in the cut-off values to describe growth hormone deficiency and reference data for growth hormone secretion in normally growing children, differences in growth hormone assays over the time, problems in reproducibility of growth hormone test results all contribute to this vagueness. However, diagnosing growth hormone deficiency is important to identify children who will benefit most from the GH treatment. GH dependent peptides, insulin-like growth factor I (IGF-I) and insulin-like growth factor-binding protein 3, (IGFBP-3) are good markers of growth hormone status and are useful in diagnosing GH deficiency as well as monitoring efficacy of growth hormone treatment. An overview of problems in the diagnosis of GH deficiency and the role of IGF-I and IGFBP-3 in the diagnosis of GH deficiency is provided in this paper.