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How useful are serum IGF-I measurements for managing GH replacement therapy in adults and children?

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Abstract

The optimal dosing of growth hormone (GH) therapy is challenging due to high inter-individual variability in subcutaneous GH absorption and sensitivity to the drug. Optimal dosing would maximize patient gains in height, body composition, and metabolic outcomes while minimizing GH adverse events. The pulsatile secretion of GH, however, does not allow direct assessment of circulating GH levels as a measure of response to GH therapy. Insulin-like growth factor (IGF-I), a key marker of GH activity, has been shown to be useful in monitoring and adjusting GH dose during treatment of GH deficiency (GHD). Traditionally, monitoring IGF-I levels in response to GH therapy has been recommended for assessment of treatment compliance and safety. More recently, GH treatment guidelines have stated that IGF-I levels should also be used to guide GH dosing. This review examines whether individualized GH dosing based on the IGF-I response to GH therapy provides a better method for determining the GH replacement needs of pediatric and adult patients compared with conventional GH dosing, and whether IGF-I-based dosing improves outcomes such as height and body composition, with reduced side effects. Because IGF-I measurement presents its own difficulties, the current state of IGF-I assays is also discussed. The reviewed studies show that the use of GH dose adjustments based on IGF-I responses to GH therapy successfully reduces adverse events in adults with GHD and results in greater positive height attainment in children, without increasing adverse events. Long-term outcome studies are needed, as are internationally accepted guidelines for IGF-I measurement.

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Acknowledgments

The authors wish to thank Lynanne McGuire, PhD of MedVal Scientific Information Services, LLC, for providing medical writing and editorial assistance. Funding to support the preparation of this manuscript was provided by Novo Nordisk Inc.

Conflict of interest

Dr. Cohen has received honoraria from Novo Nordisk Inc., Ipsen, and Teva. Dr. Cook has received honoraria from Novo Nordisk Inc., Endo, and Pfizer Inc. for advisory board consultation and from Eli Lilly for grant support. He is a speaker for Eli Lilly, Pfizer Inc., and Novo Nordisk Inc.

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Authors and Affiliations

  1. Division of Pediatric Endocrinology, Department of Pediatrics, Mattel Children’s Hospital, University of California at Los Angeles, Los Angeles, CA, USA

    Anna Pawlikowska-Haddal & Pinchas Cohen

  2. Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97201-3001, USA

    David M. Cook

  3. UCLA Children’s Health Center, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA, 90065, USA

    Anna Pawlikowska-Haddal & Pinchas Cohen

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  1. Anna Pawlikowska-Haddal
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Correspondence to David M. Cook.

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Pawlikowska-Haddal, A., Cohen, P. & Cook, D.M. How useful are serum IGF-I measurements for managing GH replacement therapy in adults and children?. Pituitary 15, 126–134 (2012). https://doi.org/10.1007/s11102-011-0343-y

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