SOVREMENNAYA PEDIATRIYA.2019.2(98):35-40; doi 10.15574/SP.2019.98.35

Sprinchuk N. A., Samson O. Ya., Bolshova O. V.
SI «V.P. Komisarenko Institute of Endocrinology and Metabolism NAMS of Ukraine», Kyiv
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Aim. To evaluate a role of the insulin-like growth factor-1 generation test for growth hormone in differential diagnosis and prognosis of pathogenetic treatment for the short stature with preserved somatotropic function.

Materials and methods. The group of examination included 55 children with short stature and preserved somatotropic function. The patients were aged between 5 and 16 years. Child's target growth (TG) and predicted growth (PG) were determined. The insulin-like growth factor-1 generation test for growth hormone consisting of two stages was conducted. Stage 1 included a sensitivity test for GH at a rate of 0.033 μg/kg/day, subcutaneously, for 4 days. In the absence of an increase in IGF-1 more than 2-fold, the trial was continued after 7 days (stage two): GH was administered at a dose of 0.05 mg/kg for 4 days, followed by the IGF-1 definition.

Results. Children with PG lower than TG were included into the groups for performing the insulin-like growth factor-1 generation test to growth hormone. Among 55 patients with short stature there were selected 23 patients with IGF-1 below the reference values, which amounted to 106.25±13.8 ng/ml, while others were diagnosed with idiopathic short stature (ISS). During stage 1 of test, the growth of IGF-1 content in 2 or more times was noted in 7 patients (Group I). The increase in IGF-1 from 1.5 to 2 times was recorded in 11 patients (group II). The worst indices were observed in five children (Group III), the IGF-1 content after the test was slightly increased and remained practically unchanged. Stage 2 of test was performed in patients of groups II and III. Increased IGF-1 in 1.5 and more times was obtained in 11 patients. In three children, the level of IGF-1 on stimulation had a rise more than 1, they showed a very low sensitivity to GH. Thus, due to the study of somatotropic function and the 2-stage IGF-1 generation test for growth hormone ISS was diagnosed in 43 of 55 children with the short stature without disorders of the STH function with the administration of rGH at a dose of 0.05 mg/kg/day, BIGH syndrome has been proved in 7 patients with rGH use in the initial dose of 0.035 mg/kg/day, RIGH syndrome was defined in 5 children who were recommended to treat with somatomedin drugs. On the basis of IGF-1 generation test for GH, an algorithm for differential diagnostics of the short stature under preserved somatotropic function was developed.

Conclusions. Insulin-like growth factor-1 generation test is an effective criterion for differential diagnosis of biologically inactive growth hormone syndrome, receptor insensitivity to growth hormone and idiopathic short stature. This test is highly prognostic for the application of different doses of recombinant growth hormone in patients with preserved somatotropic function.

Key words: children, generation test, insulin-like growth factor-1, biologically inactive growth hormone, receptor insensitivity, idiopathic short stature.

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Article received: Oct 18, 2018. Accepted for publication: Feb 26, 2019.