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Approach to the evaluation of the GH/IGF-axis in patients with pituitary disease: which test to order

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Abstract

The diagnosis of adult growth hormone deficiency (AGHD) and acromegaly involves assessment of serum growth hormone (GH) and insulin-like growth factor-1 (IGF-1) concentrations. The diagnosis of AGHD typically requires a provocative test of GH reserve, but is supported by demonstration of low-serum IGF-1 levels. Therapeutic monitoring of rhGH replacement is performed utilizing measurement of serum IGF-1 concentrations. In patients with suspected acromegaly, the diagnosis is confirmed by elevated serum IGF-1 levels and further validated by the presence of elevated GH levels both before and following an oral glucose load. A goal of acromegaly therapy is to normalize IGF-1 concentrations, and, depending on the therapeutic modality, GH levels as well. Using case based clinical scenarios, we have presented a standard approach to the biochemical diagnosis and therapeutic monitoring of these disorders.

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Authors and Affiliations

  1. Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Brian Roberts & Laurence Katznelson

  2. Department of Neurosurgery, Stanford University School of Medicine, 875 Blake Wilbur Drive, Stanford, CA, 94305-5826, USA

    Laurence Katznelson

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  1. Brian Roberts
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  2. Laurence Katznelson
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Correspondence to Laurence Katznelson.

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Roberts, B., Katznelson, L. Approach to the evaluation of the GH/IGF-axis in patients with pituitary disease: which test to order. Pituitary 10, 205–211 (2007). https://doi.org/10.1007/s11102-007-0026-x

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  • DOI: https://doi.org/10.1007/s11102-007-0026-x

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