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Clinical utility of measurements of insulin-like growth factor 1

Nature Clinical Practice Endocrinology & Metabolism volume 2, pages 436–446 (2006)Cite this article

Abstract

Plasma insulin-like growth factor 1 (IGF-I) concentrations are regulated by genetic factors, nutrient intake, growth hormone (GH) and other hormones such as T4, cortisol and sex steroids. The accuracy of IGF-I measurement in diagnosing GH deficiency or excess depends, in part, on the relative contributions of each of these variables. Since their respective influence may vary widely between individuals, the establishment of well-defined normal ranges is necessary, which requires adequate numbers of normal individuals, in order for IGF-I measurements to have maximum utility. In states of GH deficiency, the influence of these non-GH-related factors predominates. Although IGF-I levels have utility as a screening test in children and young adults, they cannot be used as a stand-alone test for the diagnosis of GH deficiency. By contrast, in acromegaly, GH is the predominant determinant of IGF-I levels and, therefore, measurement of IGF-I is a very useful diagnostic test. In acromegaly, IGF-I levels are useful for assessing the relative degree of GH excess, because changes in IGF-I correlate with changes in symptoms and soft-tissue growth. IGF-I is also very useful in monitoring the symptomatic response to therapy.

Key Points

  • Insulin-like growth factor 1 (IGF-I) is a useful screening test in children and young adults with growth-hormone deficiency

  • IGF-I is not a stand-alone diagnostic test for growth-hormone deficiency in adults, and a confirmatory growth-hormone-stimulation test is required

  • IGF-I can be used as a stand-alone diagnostic test for acromegaly

  • Measurement of IGF-I at the time of diagnosis in acromegaly provides useful information on disease severity

  • Monitoring the change in IGF-I levels during treatment of acromegaly provides a good index of the symptomatic response

  • Growth hormone levels after glucose suppression, and IGF-I levels, are useful predictors of treatment success in acromegaly that correlate with long-term outcome

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Figure 1: Schematic diagram of insulin, growth hormone and insulin-like growth factor 1 regulation85

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Acknowledgements

The author thanks Ms Laura Lindsey for her help in preparing the manuscript. This work was supported by a grant (HL56580) from the National Institutes of Health.

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  1. Professor of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    David R Clemmons

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Clemmons, D. Clinical utility of measurements of insulin-like growth factor 1. Nat Rev Endocrinol 2, 436–446 (2006). https://doi.org/10.1038/ncpendmet0244

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