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Cited by 26Growth Hormone and Insulin-like Growth FactorsPituitary Gland Disorders and TreatmentsTraumatic Brain Injury Research

Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion

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Lithgow, Kirstie, Chin, Alex, Debert, Chantel T., Kline, Gregory A.·2018·BMC Endocrine Disorders
DOI 10.1186/s12902-018-0247-1PMC PMC5879553
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Abstract

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 μg/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.

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  • Patients with normal IGF-1 levels can be diagnosed as having GHD on provocative testing.

    “Evaluation for growth hormone deficiency often requires GH stimulation; while IGF-1 was used as a screening test for years, it is now clear that patients with normal IGF-1 levels can be diagnosed as having GHD on provocative testing [11, 69, 70].”

    From Neuroendocrine Disruptions Following Head Injury (2023) · cites this paper as [70]

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Authors
Lithgow, K., Chin, A., Debert, C. T., & Kline, G. A.
Affiliations
University of Calgary (CA)
Corresponding author
Lithgow, Kirstie
ORCID
Venue
BMC Endocrine Disorders
Publisher
Springer Science and Business Media LLC
Published
2018-04-02
Volume
18
Issue
1
Pages
20-20
ISSN
1472-6823 (ISSN-L)
DOI
10.1186/s12902-018-0247-1
PMC
PMC5879553
OpenAlex
W2804596156
Cited by
26
References
19
Citations by year
2026: 6 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 2 · 2013: 1
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Endocrine Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Libraries and Cultural Resources (University of Calgary) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Growth Hormone and Insulin-like Growth Factors
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
growth hormone deficiency, traumatic brain injury, sports-related concussion, insulin-like growth factor I, insulin tolerance test, glucagon stimulation test, pituitary function, diagnostic screening
MeSH terms
Brain Injuries, Traumatic, Adult, Athletic Injuries, Brain Concussion, Female, Follow-Up Studies, Growth Disorders, Humans, Insulin-Like Growth Factor I, Male, Middle Aged, Prognosis, Retrospective Studies, Biomarkers, Human Growth Hormone

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