ESPE2023 Poster Category 1 GH and IGFs (48 abstracts)
Difficulties in interpreting insulin-like growth factor 1 (IGF-1) levels in short stature children born small for gestational age (SGA) treated with recombinant human growth hormone (rhGH) based on data from six clinical centres in Poland.
Marta Glińska 1 , Mieczysław Walczak 1 , Beata Wikiera 2 , Beata Pyrżak 3 , Anna Majcher 3 , Monika Paluchowska 3 , Aneta Gawlik 4 , Aleksandra Antosz 4 , Marcin Kusz 4 , Artur Bossowski 5 , Karolina Stożek 5 , Anna Wędrychowicz 6 , Jerzy Starzyk 6 & Elżbieta Petriczko 1
1Department of Pediatrics, Endocrinology, Diabetology, Metabolic Disorders and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland. 2Department of Endocrinology and Diabetology of Children and Adolescents, Wroclaw Medical University, Wrocław, Poland. 3Department of Pediatrics and Endocrinology, Medical University of Warsaw, Warszawa, Poland. 4Department of Paediatrics and Paediatric Endocrinology with Division of Sex Development Disorders, Medical University of Silesia, Upper Silesia Children's Health Centre, Katowice, Poland. 5Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland. 6Department of Endocrinology of Children and Young Adults, Jagiellonian University, Collegium Medicum, Kraków, Poland
Introduction: The assessment of IGF-1 concentrations is one of the parameters used for evaluating response to rhGH treatment. An increase in IGF-1 concentration positively correlates with growth improvement. The IGF-1 concentrations significantly above the reference range may increase total the risk of possible side effects. High IGF-1 concentration is one of the reasons for rhGH dose reduction which affects the response to treatment.
Aim: The aim of this study was to evaluate the IGF-1 local reference ranges (LRR) for the rhGH treatment centres concerned, to compare these values with the populational reference ranges (PRR) and to assess the need for modification of the rhGH dose based on the different norms.
Methods: Auxological data of SGA patients treated with rhGH between 2016 and 2020 at six university clinical polish centres were analysed. The IGF-1 levels were assessed at baseline, after 12 and 24 months, using IMMULITE 2000 XPi Immunoassay System, Elecsys® IGF-1 Roche or SM-C-RIA-CT from DIAsource ImmunoAssays S.A. The IGF-1 assay values were compared to the reference ranges provided by the local laboratory, adapted to the method used for the assay and to the populational reference ranges based on the data presented by Bedogni et al.
Results: At baseline, 185 patients (81%) remained within the normal range for IGF-1 with reference to the LRR and 215 (94%) with reference to the PRR. After 12 months, 56 patients (24%) presented IGF-1 values > 97th percentile for LRR, whereas only 8 (3.5%) for PRR; P< 0.001. After 24 months of treatment, the values were respectively: 47 (33%) > 97th percentile by LRR vs 6 (4.2%) by PRR; P<0.001. Thirty-nine patients had rhGH dose reduced after 12 months, of whom 12 (25%) had IGF-1 > 97th percentile according to the LRR and 5 (13%) > 97th percentile for the PRR. After 24 months, 35 patients required dose reduction - 23 (66%) had IGF-1 > 97th percentile for LRR and 4 (11%) for the PRR.
Conclusions: The different methods used to determine IGF-1 concentration and the different IGF-1 reference ranges result in a significant proportion of rhGH-treated children with elevated IGF-1 concentration and experiencing dose reductions, which may negatively affect growth rate. It would be optimal to determine IGF-1 levels in all children using the same method and in the same laboratory, but this is difficult to do in a country with a population similar to the Polish one.
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