Amit Tirosh1,2, Yoel Toledano2,3, Hiba Masri-Iraqi1,2, Yoav Eizenberg2,4, Gloria Tzvetov1,2, Dania Hirsch1,2, Carlos Benbassat1,2, Eyal Robenshtok1,2, Ilan Shimon5,6. 1. Endocrine Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel. 2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 3. Endocrinology Clinic, Division of Maternal Fetal Medicine, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Israel. 4. Tel Aviv-Jaffa District Clalit Health Services, Tel Aviv, Israel. 5. Endocrine Institute, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel. ilanshi@clalit.org.il. 6. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ilanshi@clalit.org.il.
Abstract
PURPOSE: To evaluate the utility of Insulin-like growth factor I (IGF-I) standard deviation score (SDS) as a surrogate marker of severity of hypopituitarism in adults with pituitary pathology. METHODS: We performed a retrospective data analysis, including 269 consecutive patients with pituitary disease attending a tertiary endocrine clinic in 1990-2015. The medical files were reviewed for the complete pituitary hormone profile, including IGF-I, and clinical data. Age-adjusted assay reference ranges of IGF-I were used to calculate IGF-I SDS for each patient. The main outcome measures were positive and negative predictive values of low and high IGF-I SDS, respectively, for the various pituitary hormone deficiencies. RESULTS: IGF-I SDS correlated negatively with the number of altered pituitary axes (p < 0.001). Gonadotropin was affected in 76.6 % of cases, followed by thyrotropin (58.4 %), corticotropin (49.1 %), and prolactin (22.7 %). Positive and negative predictive values yielded a clear trend for the probability of low/high IGF-I SDS for all affected pituitary axes. Rates of diabetes insipidus correlated with IGF-I SDS values both for the full study population, and specifically for patients with non-functioning pituitary adenomas. CONCLUSIONS: IGF-I SDS can be used to evaluate the somatotroph function, as a valid substitute to absolute IGF-I levels. Moreover, IGF-I SDS predicted the extent of hypopituitarism in adults with pituitary disease, and thus can serve as a marker of hypopituitarism severity.
PURPOSE: To evaluate the utility of Insulin-like growth factor I (IGF-I) standard deviation score (SDS) as a surrogate marker of severity of hypopituitarism in adults with pituitary pathology. METHODS: We performed a retrospective data analysis, including 269 consecutive patients with pituitary disease attending a tertiary endocrine clinic in 1990-2015. The medical files were reviewed for the complete pituitary hormone profile, including IGF-I, and clinical data. Age-adjusted assay reference ranges of IGF-I were used to calculate IGF-ISDS for each patient. The main outcome measures were positive and negative predictive values of low and high IGF-ISDS, respectively, for the various pituitary hormone deficiencies. RESULTS:IGF-ISDS correlated negatively with the number of altered pituitary axes (p < 0.001). Gonadotropin was affected in 76.6 % of cases, followed by thyrotropin (58.4 %), corticotropin (49.1 %), and prolactin (22.7 %). Positive and negative predictive values yielded a clear trend for the probability of low/high IGF-ISDS for all affected pituitary axes. Rates of diabetes insipidus correlated with IGF-ISDS values both for the full study population, and specifically for patients with non-functioning pituitary adenomas. CONCLUSIONS:IGF-ISDS can be used to evaluate the somatotroph function, as a valid substitute to absolute IGF-I levels. Moreover, IGF-ISDS predicted the extent of hypopituitarism in adults with pituitary disease, and thus can serve as a marker of hypopituitarism severity.
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