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Urinary Growth Hormone (GH), Insulin-Like Growth Factor I (IGF-I), and IGF-Binding Protein-3 Measurements in the Diagnosis of Adult GH Deficiency¹

Endocrine Sciences Research Group, University of Manchester (M.S.G., P.E.C.), Manchester, United Kingdom M13 9PT; the Department of Endocrinology, Christie Hospital National Health Service Trust (A.A.T., S.M.S.), Withington, Manchester, United Kingdom M20 4BX; the Department of Geriatric Medicine, South Manchester University Hospitals National Health Service Trust (P.A.O.), Manchester, United Kingdom M20 8LR; and the Department of Medicine, University of Virginia Health Sciences Center (M.O.T.), Charlottesville, Virginia 22908

Address all correspondence and requests for reprints to: Dr. Peter E. Clayton, Endocrine Sciences Research Group, Department of Medicine, University of Manchester, Oxford Road, Manchester, United Kingdom M13 9PT. E-mail: peter.clayton{at}man.ac.uk

The diagnosis of GH deficiency (GHD) in the elderly is based at present on the peak GH concentration during a stimulation test. We have now evaluated the performance of urinary GH (uGH), urinary insulin-like growth factor I (uIGF-I), and urinary IGF-binding protein-3 (uIGFBP-3) in the diagnosis of GHD in this group. Twenty GHD elderly patients with a history of pituitary disease and a peak GH response to arginine stimulation of less than 3 ng/mL (15 men and 5 women; age, 61.1–83.4 yr) and 19 controls (12 men and 7 women; age, 60.8–87.5 yr) were studied. GH secretion was assessed by 24-h profile and expressed as the area under the curve (AUC_GH). Serum (s) IGF-I and sIGFBP-3 were measured in a single morning, fasted sample. Urinary GH, uIGF-I, and uIGFBP-3 were measured in a 24-h urine sample collected over the same interval as the GH profile, and results were expressed as total amount excreted in 24 h (tuGH₂₄, nanograms; tuIGF-I₂₄, nanograms; tuIGFBP-3₂₄, micrograms). Data are presented as the mean ± SD, except for AUC_GH, tuGH₂₄, and tuIGFBP-3₂₄, which are presented as the geometric mean (-1, +1 tolerance factor).

AUC_GH, sIGF-I, and sIGFBP-3 were significantly lower in GHD subjects than in controls. Total uGH₂₄ was lower in GHD subjects, but tuIGF-I₂₄ and tuIGFBP-3₂₄ excretion were not different in the two groups. AUC_GH provided the best separation between GHD and control subjects, whereas there was substantial overlap for sIGF-I, sIGFBP-3, and tuGH₂₄. In both groups sIGF-I was correlated to sIGFBP-3 (GHD, r = 0.75; controls, r = 0.65; both P < 0.01), whereas tuIGF-I₂₄ was not correlated to tuIGFBP-3₂₄ in either group. Moreover, tuIGF-I₂₄ and tuIGFBP-3₂₄ were not related to their respective serum concentrations in either group. Total uGH₂₄ was correlated with AUC_GH only in controls (r = 0.54; P < 0.05). These data demonstrate that urinary GH and urinary and serum IGF-I and IGFBP-3 are not suitable diagnostic markers for GHD in elderly subjects.

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