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HelpTest Code IGFGP Insulin-Like Growth Factor 1 and Insulin-Like Growth Factor-Binding Protein 3 Growth Panel, Serum
Useful For
Diagnosing growth disorders
Diagnosing adult growth hormone deficiency
Monitoring of recombinant human growth hormone treatment
Insulin-like growth factor binding protein 3 can be used as a possible adjunct to insulin-like growth factor 1 and growth hormone in the diagnosis and follow-up of acromegaly and gigantism
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| IGFMS | IGF-1, LC/MS, S | Yes | Yes |
| IGFB3 | IGFBP-3, S | Yes | Yes |
Method Name
IGFMS: Liquid Chromatography Mass Spectrometry (LC-MS)
IGFB3: Enzyme-Labeled Chemiluminescent Immunometric Assay
Reporting Name
IGF-1 LC/MS, IGFBP-3 Growth PanelSpecimen Type
SerumNecessary Information
Indicate patient's age and sex.
Specimen Required
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: 2 Plastic vials
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge within 1 hour of collection.
2. Aliquot into 2 plastic vials in equal portions.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Frozen | 14 days |
Reference Values
INSULIN-LIKE GROWTH FACTOR 1
Males:
0-11 months: 18-156 ng/mL
1 year: 14-203 ng/mL
2 years: 16-222 ng/mL
3 years: 22-229 ng/mL
4 years: 30-236 ng/mL
5 years: 39-250 ng/mL
6 years: 47-275 ng/mL
7 years: 54-312 ng/mL
8 years: 61-356 ng/mL
9 years: 67-405 ng/mL
10 years: 73-456 ng/mL
11 years: 79-506 ng/mL
12 years: 84-551 ng/mL
13 years: 90-589 ng/mL
14 years: 95-618 ng/mL
15 years: 99-633 ng/mL
16 years: 104-633 ng/mL
17 years: 107-615 ng/mL
18-22 years: 91-442 ng/mL
23-25 years: 66-346 ng/mL
26-30 years: 60-329 ng/mL
31-35 years: 54-310 ng/mL
36-40 years: 48-292 ng/mL
41-45 years: 44-275 ng/mL
46-50 years: 40-259 ng/mL
51-55 years: 37-245 ng/mL
56-60 years: 34-232 ng/mL
61-65 years: 33-220 ng/mL
66-70 years: 32-209 ng/mL
71-75 years: 32-200 ng/mL
76-80 years: 33-192 ng/mL
81-85 years: 33-185 ng/mL
86-90 years: 33-179 ng/mL
> or=91 years: 32-173 ng/mL
Females:
0-11 months: 14-192 ng/mL
1 year: 23-243 ng/mL
2 years: 28-256 ng/mL
3 years: 31-249 ng/mL
4 years: 33-237 ng/mL
5 years: 36-234 ng/mL
6 years: 39-246 ng/mL
7 years: 44-279 ng/mL
8 years: 51-334 ng/mL
9 years: 61-408 ng/mL
10 years: 73-495 ng/mL
11 years: 88-585 ng/mL
12 years: 104-665 ng/mL
13 years: 120-719 ng/mL
14 years: 136-729 ng/mL
15 years: 147-691 ng/mL
16 years: 153-611 ng/mL
17 years: 149-509 ng/mL
18-22 years: 85-370 ng/mL
23-25 years: 73-320 ng/mL
26-30 years: 66-303 ng/mL
31-35 years: 59-279 ng/mL
36-40 years: 54-258 ng/mL
41-45 years: 49-240 ng/mL
46-50 years: 44-227 ng/mL
51-55 years: 40-217 ng/mL
56-60 years: 37-208 ng/mL
61-65 years: 35-201 ng/mL
66-70 years: 34-194 ng/mL
71-75 years: 34-187 ng/mL
76-80 years: 34-182 ng/mL
81-85 years: 34-177 ng/mL
86-90 years: 33-175 ng/mL
≥91 years: 25-179 ng/mL
Tanner Stage reference ranges:
Males
Stage I: 81-255 ng/mL
Stage II: 106-432 ng/mL
Stage III: 245-511 ng/mL
Stage IV: 223-578 ng/mL
Stage V: 227-518 ng/mL
Females
Stage I: 86-323 ng/mL
Stage II: 118-451 ng/mL
Stage III: 258-529 ng/mL
Stage IV: 224-586 ng/mL
Stage V: 188-512 ng/mL
Tanner Stage reference source: Bindlingmaier M, Friedrich N, Emeny RT, et al. Reference intervals for insulin-like growth factor-1 (igf-i) from birth to senescence: results from a multicenter study using a new automated chemiluminescence IGF-I immunoassay conforming to recent international recommendations. J Clin Endocrinol Metab. 2014;99(5):1712-1721
Note: Puberty onset (transition from Tanner stage I to Tanner stage II) occurs for boys at a median age of 11.5 (±2) years and for girls at a median age of 10.5 (±2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. For boys, there is no definite proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage V (young adult) should be reached by age 18.
INSULIN-LIKE GROWTH FACTOR-BINDING PROTEIN 3
1-7 days: ≤0.7 mcg/mL
8-14 days: 0.5-1.4 mcg/mL
15 days-11 months: Unavailable
1 year: 0.7-3.6 mcg/mL
2 years: 0.8-3.9 mcg/mL
3 years: 0.9-4.3 mcg/mL
4 years: 1.0-4.7 mcg/mL
5 years: 1.1-5.2 mcg/mL
6 years: 1.3-5.6 mcg/mL
7 years: 1.4-6.1 mcg/mL
8 years: 1.6-6.5 mcg/mL
9 years: 1.8-7.1 mcg/mL
10 years: 2.1-7.7 mcg/mL
11 years: 2.4-8.4 mcg/mL
12 years: 2.7-8.9 mcg/mL
13 years: 3.1-9.5 mcg/mL
14 years: 3.3-10 mcg/mL
15 years: 3.5-10 mcg/mL
16 years: 3.4-9.5 mcg/mL
17 years: 3.2-8.7 mcg/mL
18 years: 3.1-7.9 mcg/mL
19 years: 2.9-7.3 mcg/mL
20 years: 2.9-7.2 mcg/mL
21-25 years: 3.4-7.8 mcg/mL
26-30 years: 3.5-7.6 mcg/mL
31-35 years: 3.5-7.0 mcg/mL
36-40 years: 3.4-6.7 mcg/mL
41-45 years: 3.3-6.6 mcg/mL
46-50 years: 3.3-6.7 mcg/mL
51-55 years: 3.4-6.8 mcg/mL
56-60 years: 3.4-6.9 mcg/mL
61-65 years: 3.2-6.6 mcg/mL
66-70 years: 3.0-6.2 mcg/mL
71-75 years: 2.8-5.7 mcg/mL
76-80 years: 2.5-5.1 mcg/mL
81-85 years: 2.2-4.5 mcg/mL
Tanner Stages:
Males
Stage I: 1.4-5.2 mcg/mL
Stage II: 2.3-6.3 mcg/mL
Stage III: 3.1-8.9 mcg/mL
Stage IV: 3.7-8.7 mcg/mL
Stage V: 2.6-8.6 mcg/mL
Females
Stage I: 1.2-6.4 mcg/mL
Stage II: 2.8-6.9 mcg/mL
Stage III: 3.9-9.4mcg/mL
Stage IV: 3.3-8.1 mcg/mL
Stage V: 2.7-9.1 mcg/mL
Note: Puberty onset, ie, the transition from Tanner stage 1 (prepubertal) to Tanner stage 2 (early pubertal), occurs for girls at a median age of 10.5 (±2) years and for boys at a median age of 11.5 (±2) years. There is evidence that it may occur up to 1 year earlier in obese girls and in African American girls. By contrast, for boys there is no definite proven relationship between puberty onset and body weight or ethnic origin. Progression through Tanner stages is variable. Tanner stage 5 (young adult) should be reached by age 18.
Interpretation
Both insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3) measurements can be used to assess growth hormone (GH) excess or deficiency. However, for all applications, IGF1 measurement has generally been shown to have superior diagnostic sensitivity and specificity and should be used as the primary test. In particular, in the diagnosis and follow-up of acromegaly and gigantism, IGFBP3 measurement adds little, if anything, to IGF1 testing.
The combination of IGF1 and IGFBP3 measurements might offer some benefits over either analyte alone in the diagnosis of GH deficiency and resistance, and in the monitoring of recombinant human GH (rhGH) therapy.
Serum IGF1 and IGFBP3 concentrations below the 2.5th percentile (standard deviation score, Z-score of <-2) for age are consistent with GH deficiency or severe GH resistance, but patients with incomplete GH deficiency or mild-to-moderate GH resistance may have levels within the reference range. In GH deficiency, GH levels may also be low and can show suboptimal responses in stimulation tests (eg, exercise, clonidine, arginine, ghrelin, growth hormone-releasing hormone, insulin-induced hypoglycemia), while in severe GH resistance, GH levels might be substantially elevated. However, dynamic GH testing is not always necessary for diagnosis. If it is undertaken, it should be performed and interpreted in endocrine testing centers under the supervision of a pediatric or adult endocrinologist.
The aim of both pediatric and adult GH replacement therapy is to achieve IGF1 and IGFBP3 levels within the reference range, ideally within the middle-to-upper third. Higher levels are rarely associated with any further therapeutic gains but could potentially lead to long-term problems of GH excess.
Elevated IGF1 and IGFBP3 levels support the diagnosis of acromegaly or gigantism in individuals with appropriate signs or symptoms. In successfully-treated patients, both levels should be within the normal range, ideally within the lower third. In both diagnosis and follow-up, IGF1 levels correlate better with clinical disease activity than IGFBP3 levels.
After transsphenoidal removal of pituitary tumors in patients with acromegaly, IGF-I concentration starts to decrease and returns to normal levels in most patients postoperatively by the fourth day.
Persons with anorexia or malnutrition have low values of IGF1. IGF1 is a more sensitive indicator than prealbumin, retinol-binding protein, or transferrin for monitoring nutritional repletion.
Clinical Reference
1. Wetterau L, Cohen P. Role of insulin-like growth factor monitoring in optimizing growth hormone therapy. J Ped Endocrinol Metab. 2000;13:1371-1376
2. Granada ML, Murillo J, Lucas A, et al. Diagnostic efficiency of serum IGF-1, IGF-binding protein-3 (IGFBP-3), IGF/IGFBP-3 molar ratio and urinary GH measurements in the diagnosis of adult GH deficiency: importance of an appropriate reference population. Eur J Endocrinol. 2000;142:243-253
3. Parama C, Fluiters E, de la Fuente J, et al. Monitoring of treatment success in patients with acromegaly: the value of serum insulin-like growth factor binding protein-3 and serum leptin measurements in comparison to plasma insulin-like growth factor 1 determination. Metabolism. 2001;50:1117-1121
4. Monzavi R, Cohen P. IGFs and IGFBPs: role in health and disease. Best Pract Res Clin Endocrinol Metab. 2002;16:433-447
5. Boquete HR, Sobrado PG, Fideleff HL, et al. Evaluation of diagnostic accuracy of insulin-like growth factor (IGF)-1 and IGF-binding protein-3 in growth hormone-deficient children and adults using ROC plot analysis. J Endocrinol Metab. 2003;88:4702-4708
6. Brabant G. Insulin-like growth factor-I: marker for diagnosis of acromegaly and monitoring the efficacy of treatment. Eur J Endocrinol. 2003;148:S15-S20
7. Boscato LM, Stuart MC. Heterophilic antibodies: a problem for all immunoassays. Clin Chem. 1988;34:27-33
8. Maus A, Kemp J, Milosevic D, et al. Center of mass calculation in combination with MS/MS allows robust identification of single amino acid polymorphisms in clinical measurements of insulin-like growth factor-1. J Proteome Res. 2020;19(1):186-193. doi:10.1021/acs.jproteome.9b00494
Day(s) Performed
Monday through Saturday
Results reported: Monday through Friday
Report Available
4 to 8 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
83520
84305
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| IGFGP | IGF-1 LC/MS, IGFBP-3 Growth Panel | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| IGFB3 | IGFBP-3, S | 2483-6 |
| 62750 | IGF-1, LC/MS, S | 2484-4 |
| 35781 | Z-score | 73561-3 |