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Insulin – like Growth Factor (IGF -1)

Hormone/ Element
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Report in 48Hrs

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Fasting Required

Details

Primarily produced in the liver in response to growth hormone (GH) stimulation

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Insulin-like Growth Factor (IGF-1) Test Guide

  • Why is it done?
    • Measures circulating levels of IGF-1, a hormone produced primarily by the liver in response to growth hormone (GH) stimulation; serves as a reliable indicator of growth hormone secretion and metabolic status
    • Evaluates growth disorders in children, including assessment of growth failure, short stature, and abnormal growth patterns to differentiate between constitutional delays and pathological conditions
    • Diagnoses acromegaly and gigantism by detecting elevated IGF-1 levels associated with excessive growth hormone production
    • Identifies growth hormone deficiency in children and adults presenting with symptoms such as poor growth, decreased muscle mass, increased body fat, and reduced energy levels
    • Monitors effectiveness of growth hormone replacement therapy and acromegaly treatment to ensure appropriate dosing and therapeutic response
    • Evaluates nutritional status and liver function, as IGF-1 is a marker of protein nutrition and hepatic synthetic capacity
    • Typically performed during initial evaluation of growth abnormalities, as part of baseline assessment before growth hormone therapy, and at regular intervals during treatment monitoring
  • Normal Range
    • Normal reference ranges vary significantly based on age, sex, and pubertal status, as IGF-1 levels change throughout development
    • Typical Adult Ranges: 53-331 ng/mL or 7-43 nmol/L (ranges vary by laboratory and may differ slightly based on assay method)
    • Pediatric Ranges: Significantly higher than adults, ranging from 40-500+ ng/mL depending on age and pubertal stage; values typically peak during adolescence then decline in adulthood
    • Interpretation of Results:
    • Normal: Results within age and sex-appropriate reference range indicate adequate growth hormone production and normal metabolic function
    • Low/Below Normal: Suggests growth hormone deficiency, malnutrition, liver disease, chronic illness, or other conditions causing reduced GH secretion
    • High/Above Normal: May indicate acromegaly, gigantism, certain tumors, or can occur during puberty and pregnancy when levels naturally elevate
    • Measurement units: ng/mL (nanograms per milliliter) or nmol/L (nanomoles per liter); conversion factor is 1 ng/mL = 0.131 nmol/L
  • Interpretation
    • Low IGF-1 Levels:
    • May indicate growth hormone deficiency requiring further evaluation with stimulation tests (insulin tolerance test, arginine stimulation test)
    • Associated with malnutrition, severe illness, liver cirrhosis, hypothyroidism, or inadequate caloric intake
    • In children, suggests constitutional growth delay, familial short stature, or pathological growth hormone deficiency requiring treatment
    • High IGF-1 Levels:
    • Strongly suggests acromegaly in adults (chronic excessive growth hormone production from pituitary adenoma) requiring imaging studies and suppression testing
    • In children and adolescents, may reflect normal pubertal development, constitutional tall stature, or gigantism if markedly elevated
    • Can indicate certain malignancies producing growth hormone-releasing hormone (GHRH) or IGF-2
    • Factors Affecting IGF-1 Levels:
    • Age and pubertal status: Peak levels during puberty, decline with aging; age-specific reference ranges are essential for accurate interpretation
    • Nutritional status: Malnutrition significantly reduces IGF-1 independently of growth hormone levels; protein deficiency is particularly influential
    • Liver function: Impaired hepatic synthesis reduces IGF-1 production; cirrhosis can cause falsely low values despite normal GH secretion
    • Thyroid function: Hypothyroidism suppresses IGF-1; hyperthyroidism may elevate levels
    • Estrogen status: Oral estrogen therapy may suppress IGF-1; natural estrogen fluctuations affect levels in women
    • Chronic disease: Diabetes, renal disease, and inflammatory conditions can reduce IGF-1 despite adequate GH production
    • Exercise and stress: Acute physical stress may temporarily alter levels; chronic exercise training can increase IGF-1
    • Clinical Significance:
    • Single IGF-1 measurement is valuable screening tool; more reliable than random GH levels due to GH's pulsatile secretion pattern
    • Serial measurements track therapeutic response in GH replacement therapy or acromegaly treatment with sensitivity and specificity superior to random GH measurements
    • Borderline results may require repeat testing and correlation with clinical presentation and other diagnostic findings
  • Associated Organs
    • Primary Organ Systems:
    • Anterior pituitary gland: Source of growth hormone (somatotropin) that stimulates IGF-1 production; pituitary tumors or dysfunction directly affect IGF-1 levels
    • Liver: Primary site of IGF-1 synthesis and secretion; hepatic dysfunction, cirrhosis, or failure reduces IGF-1 production independent of GH status
    • Hypothalamus: Controls pituitary GH secretion via GHRH and somatostatin; hypothalamic lesions or dysfunction impair IGF-1 levels
    • Medical Conditions Associated with Abnormal Results:
    • Acromegaly: Pituitary adenoma secreting excess growth hormone; markedly elevated IGF-1 with characteristic clinical features (enlarged hands, feet, facial features)
    • Gigantism: Excessive GH production in children before epiphyseal plate closure; results in extreme height and elevated IGF-1
    • Growth hormone deficiency: Congenital or acquired pituitary insufficiency causing short stature in children and metabolic dysfunction in adults
    • Liver cirrhosis: Advanced hepatic disease impairs IGF-1 synthesis; may show disproportionately low levels compared to other metabolic markers
    • Hypothyroidism: Reduced thyroid hormone impairs GH secretion and IGF-1 production; correction of thyroid status improves IGF-1
    • Type 1 and Type 2 diabetes: Both can suppress IGF-1 levels independent of GH status; poor glycemic control particularly affects levels
    • Chronic kidney disease: Uremia and metabolic derangements reduce IGF-1; renal failure patients often show abnormally low levels
    • Malnutrition and eating disorders: Severe protein-calorie malnutrition markedly suppresses IGF-1; seen in anorexia nervosa and cachexia
    • Potential Complications/Risks of Abnormal Results:
    • Elevated IGF-1 (acromegaly): Increased risk of cardiovascular disease, hypertension, diabetes, sleep apnea, arthropathy, and colon cancer if untreated
    • Low IGF-1 (GH deficiency): Associated with decreased quality of life, increased mortality risk, reduced bone density (osteoporosis), impaired wound healing, and increased cardiovascular events
    • Pituitary adenomas: May cause mass effects including vision loss, headaches, cranial nerve palsies, or hypopituitarism affecting multiple hormone axes
    • Untreated growth disorders in children: Growth hormone deficiency leads to short stature with significant psychosocial implications; delayed diagnosis compromises final height potential
  • Follow-up Tests
    • If IGF-1 is Low (Suspected GH Deficiency):
    • Growth hormone stimulation tests (insulin tolerance test, arginine stimulation, glucagon stimulation) to confirm GH deficiency; single GH measurement insufficient due to pulsatile secretion
    • Pituitary hormone panel: Assess other anterior pituitary hormones (ACTH, TSH, LH, FSH, prolactin) for multiple pituitary hormone deficiency
    • Pituitary MRI: Imaging to detect pituitary adenoma, craniopharyngioma, or other structural lesions if pituitary pathology suspected
    • Liver function tests: If hepatic disease suspected, assess for cirrhosis or hepatic dysfunction contributing to low IGF-1
    • Thyroid function tests (TSH, free T4): Rule out hypothyroidism as cause of suppressed IGF-1
    • Nutritional assessment and prealbumin: Evaluate for malnutrition as contributing factor to reduced IGF-1
    • If IGF-1 is High (Suspected Acromegaly):
    • Growth hormone suppression test (oral glucose tolerance test): GH levels should suppress to <1 ng/mL with 75g glucose if acromegaly present; failure to suppress confirms diagnosis
    • Pituitary MRI with contrast: Essential imaging to localize GH-secreting adenoma and assess for mass effects or optic chiasm compression
    • 24-hour urine free cortisol and low-dose dexamethasone suppression: Screen for concurrent Cushing's syndrome in pituitary adenoma patients
    • Formal visual field testing and ophthalmologic examination: Assess for mass effect on optic pathways if macroadenoma suspected
    • Cardiovascular assessment: ECG and echocardiography to evaluate for left ventricular hypertrophy and cardiac complications in acromegaly
    • Metabolic screening: Fasting glucose and lipid panel to assess for acromegaly-associated metabolic syndrome and diabetes
    • During Treatment Monitoring:
    • Serial IGF-1 measurements: Every 4-6 weeks during GH replacement therapy dose titration; every 6-12 months during maintenance therapy
    • Repeated GH suppression testing: Post-treatment in acromegaly to confirm biochemical control; target GH <1 ng/mL and normalized IGF-1
    • Height measurements and growth velocity assessment: In children receiving GH replacement to document growth response
    • Follow-up pituitary imaging: MRI at 3-6 months post-treatment initiation or if clinical deterioration occurs to assess treatment response
    • Long-term metabolic and complication screening: Annual assessment of cardiovascular status, glucose metabolism, and bone density in chronic GH disorders
  • Fasting Required?
    • No fasting is required for IGF-1 testing. The test can be performed in non-fasting state with minimal impact on accuracy
    • Timing of Collection:
    • Can be drawn at any time of day; IGF-1 is stable throughout the day and does not exhibit the dramatic pulsatile variations seen with growth hormone
    • No specific meal restrictions necessary; light meal or food does not significantly alter results
    • Medication Considerations:
    • No need to hold growth hormone replacement therapy; testing should occur approximately 12-24 hours after injection when levels are stable in many patients
    • Estrogen-containing medications (oral contraceptives, hormone replacement therapy) should be noted as they suppress IGF-1; may need dosing adjustment for accurate baseline interpretation
    • Insulin and antidiabetic medications do not require cessation; continue as prescribed
    • Somatostatin analogs (octreotide, lanreotide) will suppress IGF-1; timing of test relative to medication administration should be noted
    • Special Patient Preparation:
    • Rest: Encourage 5-10 minutes of quiet rest before blood draw to minimize stress-related fluctuations in GH and IGF-1
    • Patient positioning: Have patient seated or supine for 5-10 minutes before draw; acute position changes may temporarily affect results
    • Age documentation: Record patient age and sex for proper reference range interpretation; age-based ranges are critical for accurate result interpretation
    • Menopausal status in women: Document if applicable, as estrogen affects IGF-1 levels and warrants different reference ranges
    • Clinical notes: Inform laboratory of relevant clinical context (recent illness, nutritional status, liver function) to guide interpretation

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