Consensus statement on the standardization and evaluation of growth hormone and insulin-like growth factor assays.

Growth hormone (GH) and insulin-like growth factor I (IGF-I) measurements are widely used in the diagnosis of disorders of GH secretion, evaluation of children with short stature from multiple causes, management of disorders that lead to nutritional insufficiency or catabolism, and monitoring both GH and IGF-I replacement therapy. Therefore, there is an ongoing need for accurate and precise measurements of these 2 peptide hormones. Representatives of the Growth Hormone Research Society, the IGF Society, and the IFCC convened an international workshop to review assay standardization, requirements for improving assay comparability, variables that affect assay interpretation, technical factors affecting assay performance, assay validation criteria, and the development and use of normative data. Special attention was given to preanalytical conditions, the use of international commutable reference standards, antibody specificity, matrix requirements, QC analysis, and interference by binding proteins. Recommendations for each of these variables were made for measurements of each peptide. Additionally, specific criteria for IGF-I were recommended for age ranges of normative data, consideration of Tanner staging, and consideration of the effect of body mass index. The consensus statement concludes that major improvements are necessary in the areas of assay performance and comparability. This group recommends that a commutable standard for each assay be implemented for worldwide use and that its recommendations be applied to accomplish the task of providing reliable and clinically useful results.

The International Reference Reagent for insulin-like growth factor-I.

Three preparations of recombinant DNA-derived insulin-like growth factor-I (IGF-I) were obtained, prepared in ampoules coded 86/522, 86/720 or 87/518, and evaluated as candidate International Reference Reagents in an international collaborative study (nine laboratories in four countries) in response to a request by the World Health Organization (WHO). Immunoassay dose-response curves for each of the three preparations did not in general differ significantly from those of local standards or from those of ampouled preparations of serum-derived IGF-I which were included in the study. The estimates of ampoule contents in terms of local standards showed considerable heterogeneity; the between-laboratory variability of estimates in terms of local standards was ten times greater than the inherent variability of estimates from these systems as estimated from comparisons of coded duplicates. Bioassay data were limited, and those available were inconsistent with immunoassay data. Of the three preparations, ampoules coded 86/720 were derived from an IGF-I preparation that was heterogeneous by high-performance liquid chromatography, and stability data for the preparation 86/522 were anomalous. As a result, the ampouled preparation coded 87/518 has been established by WHO as the International Reference Reagent for IGF-I for immunoassay, with an assigned ampoule content of 3.1 micrograms/ampoule, and is available from the National Institute for Biological Standards and Control.