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Prevalence of IGF1 deficiency in prepubertal children with isolated short stature

¹ Department of Paediatric Endocrinology, Hôpital des Enfants, Toulouse, France² Department of Endocrinology, Hôpital Larrey, Toulouse, France³ , Department of Biology⁴ INSERM U563, Department of Lipoprotéines et Médiateurs Lipidiques, Hôpital Purpan, Toulouse, France

(Correspondence should be addressed to M Tauber; Email: tauber.mt{at}chu-toulouse.fr)

Background/aims: ‘Primary IGF1 deficiency (IGFD)’ is defined by low levels of IGF1 without a concomitant impairment in GH secretion in the absence of secondary cause. The aims of this study were to evaluate the prevalence of non-GH deficient IGFD in prepubertal children with isolated short stature (SS) and to describe this population.

Methods: This retrospective study included all children with isolated SS seen in our Pediatric Endocrinology Unit from January 2005 to December 2007. Children were included based on the following criteria: i) SS with current height SDS –2.5, ii) age2 years, and iii) prepubertal status. Exclusion criteria were: i) identified cause of SS and ii) current or past therapy with rhGH. IGF1-deficient children were defined as children without GH deficiency and with IGF1 levels below or equal to –2 SDS.

Results: Among 65 children with isolated SS, 13 (20%) had low IGF1 levels, consistent with a diagnosis of primary IGFD, four of which were born small for gestational age and nine were born appropriate for gestational age. When compared with non-IGFD children, IGFD children had higher birth weight (–0.7 vs –1 SDS, P=0.02) and birth height (–1.7 vs –2 SDS, P=0.04) and more delayed bone age (2.6 vs 1.7 years, P=0.03).

Conclusion: The prevalence of primary IGFD was 20% in children with isolated SS. Concerning the pathophysiology, our study emphasizes that IGFD in some children may be secondary to nutritional deficiency or to maturational delay.