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Score of Blum et al for Identifying a Patient with the Growth Hormone Receptor Deficiency (GHRD, Modified Savage Score)

Purpose: To evaluate a patient for growth hormone receptor deficiency (GHRD) using the criteria of Blum et al.

Description

Blum et al developed new biochemical criteria for the diagnosis of growth hormone receptor deficiency (GHRD), with the addition of 2 criteria to those of Savage et al (previous section). The authors are from Tubingen University Children's Hospital (Germany), St. Bartholomew's Hospital (London) and the Karolinska Institute (Stockholm).


Parameters:

(1) basal serum growth hormone in µg/L

(2) serum IGF-I in µg/L

(3) IGF-I generation test (after administration of exogenous growth hormone)

(4) height expressed in standard deviation (Z) score

(5) percent growth hormone binding protein (based on binding uptake of I125-GH)

(plus new criteria)

(6) basal IGFBP-3 (IGF binding protein)

(7) IGFBP-3 generation (after administration of exogenous growth hormone)

 

Parameter

Finding

Points

basal serum growth hormone

< 2.5 µg/L

0

 

>= 2.5 µg/L

1

basal serum IGF-I

> 50 µg/L

0

 

<= 50 µg/L

1

IGF-I generation

>= 15 µg/L

0

 

< 15 µg/L

1

height

>= -3 standard deviations below mean

0

 

< -3 standard deviations below mean

1

percent GH binding protein

>= 10%

0

 

< 10%

1

basal IGFBP-3

>= -2 SDS (2 standard deviations below mean)

0

 

< -2 SDS

1

IGFBP-3 generation

>= 0.4 mg/L

0

 

< 0.4 mg/L

1

 

where:

• The basal serum growth hormone cutoff was changed from the Savage score. The initial value was 4 mU/L which apparently is about 2.5 µg/L.

• IGF-1 increase is now expressed in µg/L rather than as percent of intra-assay variability.

• IGF-I and IGFBP-3 generation appears to be the difference between basal level and level after administration of exogenous growth hormone).

 

total score =

= SUM(points for all 7 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 7

• A score >= 5 indicates growth hormone receptor deficiency (GHRD).

 

Limitations:

• The assays would need to be standardized to give comparable results.


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Specialty

Objective

ICD-10