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Combined evaluation of resting IGF1, N-terminal propeptide of type III procollagen and C-terminal cross-linked telopeptide of type I collagen levels might be useful for detecting inappropriate GH administration in female athletes

Unità di Endocrinologia, Dipartimento di Scienze della Salute, Università di Roma ‘Foro Italico’, Piazza Lauro de Bosis 15, 00194 Roma, Italy¹ Dipartimento di Farmacologia Medica, Università di Milano, Via Vanvitelli 32, 20129 Milano, Italy² Istituto Auxologico Italiano, Laboratorio Sperimentale Ricerche Auxo-Endocrinologiche (LSRAE)³ , Laboratorio di Biologia Molecolare⁴ Divisione Malattie Metaboliche III, IRCCS, 20145 Milano e 28044 Piancavallo (VB), Italy

(Correspondence should be addressed to L Di Luigi; Email: luigi.diluigi{at}iusm.it)

Objective: To detect exogenous recombinant human GH (rhGH) abuse in female athletes.

Design: GH-dependent markers were assayed in serum of 100 female athletes (control group) and in a subgroup of nine female subjects treated with rhGH (0.09 IU/kg body weight, 6 days/week for 3 weeks).

Methods: Cut-off values (mean+2 S.D.) for IGF1, N-terminal propeptide of type III procollagen (PIIINP) and C-terminal telopeptide of type I collagen (ICTP) were calculated and arbitrary scores (1.5 or 2.0) were assigned to abnormal markers. By using the sum of individual marker scores, positive (3) or negative (<3) scores were obtained.

Results: None of the control group obtained a positive score (3). Abnormal IGF1, PIIINP and ICTP levels were found in 61.4, 54.5 and 11.4% samples of the treated group. Overall, positive cases were present in 43.2% blood samples drawn in subjects treated with rhGH and in 26% of samples after rhGH withdrawal. The sensitivity of the detection approach was 66.6% at the end of 3-week rhGH treatment and 11.1% at the 15th day of rhGH withdrawal, while the specificity was 100%.

Conclusion: Detection test for rhGH administration appears less sensitive in female (66.6%) than in male athletes (previous observation, 100% after 3 weeks of comparable rhGH dose), but shows a similar specificity (98.5–100%). Since athletes supposedly use very high doses and long-term administration of rhGH for doping purposes, it is foreseen that the here-in detection test would in future increase its strength.