Impact of the Choice of IGF-I Assay and Normative Dataset on the Diagnosis and Treatment of Growth Hormone Deficiency in Children

Maarten A.C. Broeren, Johannes G. Krabbe, Lianne S. Boesten, Anita C.S. Hokken-Koelega, Yolanda B. De Rijke

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)


Background: The analysis of insulin-like growth factor I (IGF-I) is an important tool for pediatricians in the diagnosis and treatment of growth hormone deficiency in children. However, significant differences exist in IGF-I assays and normative datasets, which can have important clinical consequences. Methods: IGF-I analyses were performed using the IDS-iSYS platform on 1,897 samples from pediatric patients (0.5-18 years old). Z-scores were calculated based on normative IGF-I data from Bidlingmaier et al. (SD-BM) [J Clin Endocrinol Metab. 2014 May; 99(5): 1712-21] and normative IGF-I data from the IGF-I harmonization program in the Netherlands (SD-NL). The differences in Z-scores were analyzed at relevant clinical decision points (-2 SD, +2 SD). These normative datasets were also compared to normative data reported by Elmlinger et al. [Clin Chem Lab Med. 2004; 42(6): 654-64]. Results: The difference in Z-score between SD-BM and SD-NL was highest in males between 0 and 3 years old, exceeding 2 SD. Clinically relevant discordance between both Z-scores at-2 and +2 SD was found in 12.7% of all samples. The IGF-I levels at-2 and +2 SD reported in the normative dataset of Elmlinger et al. were up to 100% higher than the IGF-I levels reported by Bidlingmaier et al. or the Dutch harmonization program. Conclusion: Pediatricians and laboratory specialists should be aware of relevant differences that can exist between IGF-I assays and normative data. Well-defined pediatric reference ranges for the IDS-iSYS platform are highly desirable.

Original languageEnglish
Pages (from-to)181-189
Number of pages9
JournalHormone Research in Paediatrics
Issue number3
Publication statusPublished - 1 Nov 2018


  • Growth hormone deficiency in children
  • Harmonization
  • Insulin-like growth factor I
  • Normative dataset
  • Z-score
  • Choice Behavior
  • Humans
  • Child, Preschool
  • Infant
  • Male
  • Reference Values
  • Growth Charts
  • Growth Disorders/blood
  • Human Growth Hormone/deficiency
  • Dwarfism, Pituitary/blood
  • Adolescent
  • Female
  • Retrospective Studies
  • Datasets as Topic/standards
  • Insulin-Like Growth Factor I/analysis
  • Netherlands/epidemiology
  • Child


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