|Values are valid only on day of printing.|
Diagnosis of acromegaly and assessment of treatment efficacy (in conjunction with glucose suppression test)
Diagnosis of human growth hormone deficiency (in conjunction with growth hormone stimulation test)
The anterior pituitary secretes human growth hormone (hGH) in response to exercise, deep sleep, hypoglycemia, and protein ingestion. hGH stimulates hepatic insulin-like growth factor-1 and mobilizes fatty acids from fat deposits to the liver. Hyposecretion of hGH causes dwarfism in children. Hypersecretion causes gigantism in children or acromegaly in adults.
Because hGH levels in normal and diseased populations overlap, hGH suppression and stimulation tests are needed to evaluate conditions of hGH excess and deficiency; random hGH levels are inadequate.
Males: 0.01-0.97 ng/mL
Females: 0.01-3.61 ng/mL
Reference intervals have not been formally verified in-house for pediatric and adolescent patients. The published literature indicates that reference intervals for adult, pediatric, and adolescent patients are comparable.
Acromegaly: For suppression testing, normal subjects have a nadir growth hormone (GH) concentration of <0.3 ng/mL after ingestion of a 75-gram glucose dose. Patients with acromegaly fail to show normal suppression. Using the Access ultrasensitive hGH assay, a cutoff of 0.53 ng/mL for nadir GH was found to most accurately differentiate patients with acromegaly in remission from active disease with a sensitivity of 97% (95% CI, 83%-100%) and a specificity of 100% (95% CI, 82%-100%).(1)
Deficiency: A normal response following stimulation tests is a peak GH concentration >5 ng/mL in children and >4 ng/mL in adults. For children, some experts consider GH values between 5 ng/mL and 8 ng/mL equivocal and only GH peak values >8 ng/mL as truly normal. Low levels, particularly under stimulation, indicate human growth hormone deficiency.
The test has limited value in assessing growth hormone secretion in normal children. IGF1I / Insulin-Like Growth Factor 1, Serum is recommended as the first test for assessing deficient or excess growth during childhood and adolescent development; reference intervals for Tanner stages are available. Suspected causes of dwarfism need to be diagnosed with the aid of provocative testing.
This test is not useful as a screen for acromegaly; IGF1 / Insulin-Like Growth Factor 1, Serum is preferred. Elevated levels of human growth hormone indicate the possibility of gigantism or acromegaly, but must be confirmed with stimulation and suppression testing.
Growth hormone is secreted in surges; single measurements are of limited diagnostic value.
1. Bancos I, Algeciras-Schimnich A, Woodmansee WW, et al: Determination of nadir growth hormone concentration cutoff following oral glucose tolerance testing using the Beckman Coulter ultrasensitive growth hormone assay patients with newly diagnosed acromegaly, acromegaly in remission, and healthy subjects. Endocr Pract 2013 Jun 27:1-26 (Epub ahead of print)
2. Camacho-Hubner C: Assessment of growth hormone status in acromegaly: what biochemical markers to measure and how? Growth Hormone IGF Res 2000;10 Suppl B:S125-299
3. Nilsson AG: Effects of growth hormone replacement therapy on bone markers and bone mineral density in growth hormone-deficient adults. Horm Res 2000;54 Suppl 1:52-57
4. Strasburger CJ, Dattani MT: New growth hormone assays: potential benefits. Acta Paediatr 1997 Nov;Suppl 423:5-11
5. Okada S, Kopchick JJ: Biological effects of growth hormone and its antagonist. Trends Mol Med 2001Mar;7:126-132
6. Veldhuis JD, Iranmanesh A: Physiological regulation of human growth hormone (GH)-insulin-like growth factor type I (IGF-I) axis: predominant impact of age, obesity, gonadal function, and sleep. Sleep 1996;19:S221-224