BIOCHEMICAL DIAGNOSTIC STRATEGIES IN THE EVALUATION OF SHORT STATURE - THE DIAGNOSIS OF INSULIN-LIKE GROWTH-FACTOR DEFICIENCY

The cornerstones in the evaluation of short stature are auxology and b iochemical testing. Traditionally, the diagnosis of growth hormone (GH ) deficiency has been based upon measurement of serum concentrations o f GH following either physiological or pharmacological stimulation, or determination of spontaneous GH secretory patterns. Assessment of pit uitary GI-I secretion is, however, fraught with problems, including th e nonphysiological nature of provocative testing, the reliance on arbi trary definitions of subnormal responses, the inadequate attention pai d to age- and puberty-related variability, and the dependence upon ass ays with marginal concordancy. It is proposed that the evaluation of s hort stature is best pursued by careful auxology plus assessment of th e insulin-like growth factor (IGF) axis, with particular attention to measurements of serum concentrations of IGF-I and IGF-binding protein- 3. The diagnosis of IGF deficiency can then be readily established, an d its etiology pursued logically.