Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty
ObjectiveIt can be challenging to determine the correct dosage of recombinant growth hormone (GH) in children with GH deficiency, leading to highly variable treatment responses. Insulin-like growth factor-1 (IGF-1) is a tool for monitoring GH treatment and dosing. However, IGF-1 levels depend on sex...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-01-01
|
| Series: | Frontiers in Endocrinology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2024.1514935/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832592644873650176 |
|---|---|
| author | Helena-Jamin Ly Helena-Jamin Ly Carina Ankarberg-Lindgren Hans Fors Hans Fors Staffan Nilsson Jovanna Dahlgren Jovanna Dahlgren |
| author_facet | Helena-Jamin Ly Helena-Jamin Ly Carina Ankarberg-Lindgren Hans Fors Hans Fors Staffan Nilsson Jovanna Dahlgren Jovanna Dahlgren |
| author_sort | Helena-Jamin Ly |
| collection | DOAJ |
| description | ObjectiveIt can be challenging to determine the correct dosage of recombinant growth hormone (GH) in children with GH deficiency, leading to highly variable treatment responses. Insulin-like growth factor-1 (IGF-1) is a tool for monitoring GH treatment and dosing. However, IGF-1 levels depend on sex, age, and pubertal stage, amongst other factors, making its interpretation somewhat difficult. This study aimed to evaluate descriptively a group of 93 children treated per protocol with GH to assess the influence of pubertal signs and sex steroid levels on the interpretation of IGF-1.Methods93 (67 boys and 26 girls) prepubertal children who participated in a previous GH treatment trial were included. Age, pubertal stage, weight, height, GH dose, and IGF-1 plasma concentrations were collected at least yearly from 2 years before pubertal start and 3 years after pubertal start. Levels of estradiol in girls and testosterone in boys were analyzed from previously collected frozen samples.ResultsNine of 58 (15.5%) estradiol samples in girls with Tanner breast stage 1 had pubertal levels of estradiol ≥25 pmol/L. For boys with testes size <4 mL, 24 out of the 153 (15.7%) testosterone samples were above the pubertal cut-off, ≥0.47 nmol/L. All the IGF-1 samples were divided into two groups based on an IGF-1 standard deviation score (SDS) of ≥2 or <2 SDS. The IGF-1 ≥2 SDS samples had a higher median (range) GH dose, 0.042 (0.02-0.10) mg/kg/day, compared with the IGF-1 <2 SDS samples, 0.038 (0.01-0.10) mg/kg/day, p<0.001. In the IGF-1 ≥2 SDS samples vs the IGF <2 SDS samples, estradiol levels were lower among girls, 13 (3-214) vs 102 (1-1070) pmol/L p<0.001, and testosterone levels were lower among boys, 0.35 (0.11-27.2) vs 6.9 (0.04-31.2) nmol/L p<0.001.ConclusionInterpretation of IGF-1 near puberty is challenging due to the influence of sex steroids. Variations in sex steroid levels and pubertal status can lead to misleading interpretations and an overestimation of IGF-1 SDS. Establishing an IGF-1 reference range that includes sex steroid levels can improve its clinical use to monitor GH treatment. |
| format | Article |
| id | doaj-art-636bf43a98f04b75bfea36813b0f4586 |
| institution | Kabale University |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj-art-636bf43a98f04b75bfea36813b0f45862025-01-21T05:43:21ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-01-011510.3389/fendo.2024.15149351514935Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early pubertyHelena-Jamin Ly0Helena-Jamin Ly1Carina Ankarberg-Lindgren2Hans Fors3Hans Fors4Staffan Nilsson5Jovanna Dahlgren6Jovanna Dahlgren7Department of Pediatrics, Göteborg Pediatric Growth Research Center (GP-GRC), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Pediatric Endocrinology, Sahlgrenska University Hospital, Queen Silvia Children Hospital, Gothenburg, SwedenDepartment of Pediatrics, Göteborg Pediatric Growth Research Center (GP-GRC), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Pediatrics, Göteborg Pediatric Growth Research Center (GP-GRC), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Pediatric Endocrinology, Sahlgrenska University Hospital, Queen Silvia Children Hospital, Gothenburg, SwedenDepartment of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Pediatrics, Göteborg Pediatric Growth Research Center (GP-GRC), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Pediatric Endocrinology, Sahlgrenska University Hospital, Queen Silvia Children Hospital, Gothenburg, SwedenObjectiveIt can be challenging to determine the correct dosage of recombinant growth hormone (GH) in children with GH deficiency, leading to highly variable treatment responses. Insulin-like growth factor-1 (IGF-1) is a tool for monitoring GH treatment and dosing. However, IGF-1 levels depend on sex, age, and pubertal stage, amongst other factors, making its interpretation somewhat difficult. This study aimed to evaluate descriptively a group of 93 children treated per protocol with GH to assess the influence of pubertal signs and sex steroid levels on the interpretation of IGF-1.Methods93 (67 boys and 26 girls) prepubertal children who participated in a previous GH treatment trial were included. Age, pubertal stage, weight, height, GH dose, and IGF-1 plasma concentrations were collected at least yearly from 2 years before pubertal start and 3 years after pubertal start. Levels of estradiol in girls and testosterone in boys were analyzed from previously collected frozen samples.ResultsNine of 58 (15.5%) estradiol samples in girls with Tanner breast stage 1 had pubertal levels of estradiol ≥25 pmol/L. For boys with testes size <4 mL, 24 out of the 153 (15.7%) testosterone samples were above the pubertal cut-off, ≥0.47 nmol/L. All the IGF-1 samples were divided into two groups based on an IGF-1 standard deviation score (SDS) of ≥2 or <2 SDS. The IGF-1 ≥2 SDS samples had a higher median (range) GH dose, 0.042 (0.02-0.10) mg/kg/day, compared with the IGF-1 <2 SDS samples, 0.038 (0.01-0.10) mg/kg/day, p<0.001. In the IGF-1 ≥2 SDS samples vs the IGF <2 SDS samples, estradiol levels were lower among girls, 13 (3-214) vs 102 (1-1070) pmol/L p<0.001, and testosterone levels were lower among boys, 0.35 (0.11-27.2) vs 6.9 (0.04-31.2) nmol/L p<0.001.ConclusionInterpretation of IGF-1 near puberty is challenging due to the influence of sex steroids. Variations in sex steroid levels and pubertal status can lead to misleading interpretations and an overestimation of IGF-1 SDS. Establishing an IGF-1 reference range that includes sex steroid levels can improve its clinical use to monitor GH treatment.https://www.frontiersin.org/articles/10.3389/fendo.2024.1514935/fullgrowth hormone dosinggrowth hormone treatmentinsulin-like growth factor-1pubertal signssex steroid |
| spellingShingle | Helena-Jamin Ly Helena-Jamin Ly Carina Ankarberg-Lindgren Hans Fors Hans Fors Staffan Nilsson Jovanna Dahlgren Jovanna Dahlgren Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty Frontiers in Endocrinology growth hormone dosing growth hormone treatment insulin-like growth factor-1 pubertal signs sex steroid |
| title | Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty |
| title_full | Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty |
| title_fullStr | Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty |
| title_full_unstemmed | Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty |
| title_short | Interpreting IGF-1 in children treated with recombinant growth hormone: challenges during early puberty |
| title_sort | interpreting igf 1 in children treated with recombinant growth hormone challenges during early puberty |
| topic | growth hormone dosing growth hormone treatment insulin-like growth factor-1 pubertal signs sex steroid |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2024.1514935/full |
| work_keys_str_mv | AT helenajaminly interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT helenajaminly interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT carinaankarberglindgren interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT hansfors interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT hansfors interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT staffannilsson interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT jovannadahlgren interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty AT jovannadahlgren interpretingigf1inchildrentreatedwithrecombinantgrowthhormonechallengesduringearlypuberty |