Aimaretti Gianluca, Corneli Ginevra, Rovere Silvia, Granata Riccarda, Baldelli Roberto, Grottoli Silvia, Ghigo Ezio
Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy.
Horm Res. 2004;62 Suppl 1:26-33. doi: 10.1159/000080755.
The current guidelines state that, within the appropriate clinical context, the diagnosis of adult growth hormone (GH) deficiency must be made biochemically using provocative tests. Measurement of insulin-like growth factor I (IGF-I) and binding protein 3 (IGFBP-3) levels cannot always distinguish between healthy and GH-deficient individuals. In particular, IGFBP-3 as a marker of GH status is clearly less sensitive than IGF-I and there is general agreement that its measurement does not provide useful diagnostic information. However, the diagnostic value of measuring IGF-I levels has been revisited recently. It has been confirmed that normal IGF-I levels do not rule out severe GH deficiency (GHD) in adults, in whom the diagnosis has therefore to be based on the demonstration of severe impairment of the peak GH response to provocative tests. It has also been emphasized that very low IGF-I levels in patients with high suspicion of GHD could be considered to be definite evidence for severe GHD. This assumption particularly applies to patients with childhood-onset, severe GHD or with multiple hypopituitary deficiencies acquired in adulthood. In addition, the use of IGF-I levels to monitor the efficacy and adequacy of recombinant human GH replacement remains widely accepted.
当前指南指出,在适当的临床背景下,成人生长激素(GH)缺乏症的诊断必须通过激发试验进行生化诊断。胰岛素样生长因子I(IGF-I)和结合蛋白3(IGFBP-3)水平的测量并不总能区分健康个体和GH缺乏个体。特别是,IGFBP-3作为GH状态的标志物明显不如IGF-I敏感,并且人们普遍认为其测量不能提供有用的诊断信息。然而,最近对测量IGF-I水平的诊断价值进行了重新审视。已经证实,正常的IGF-I水平不能排除成人严重生长激素缺乏症(GHD),因此成人GHD的诊断必须基于激发试验中GH峰值反应严重受损的证据。还强调,高度怀疑GHD的患者中极低的IGF-I水平可被视为严重GHD的确切证据。这一假设尤其适用于儿童期发病的严重GHD患者或成年后获得的多种垂体功能减退患者。此外,使用IGF-I水平监测重组人生长激素替代治疗的疗效和充分性仍然被广泛接受。