Insulin like growth factor 1 as an indicator of growth hormone deficiency

Insulin like growth factor 1 is a protein produced by the liver under the effect of Growth hormone. It is used as a screening test in the evaluation of patients suspected to have growth hormone deficiency. The aim of the study was to determine the value of Insulin like growth factor 1 level as an Indicator of growth hormone deficiency. This is a retrospective simple analytical study of 103 files of clinically diagnosed patients with short stature, was conducted in the period between June 2010 to November 2012 in the endocrine clinic at Queen Rania Al-Abdullah Hospital for Children. Seventy Patients were males while 33 patients were females, age ranged between 2 and 19 years. Al of these patients were evaluated clinically, height recorded using a stadiometer. Baseline routine laboratory studies, thyroid function test, celiac disease screening, and bone age were done for the patients. Insulin like growth factor 1 level and growth hormone stimulation test were performed for every patient. Patients with celiac disease, primary hypothyroidism, Turner syndrome, achondroplasia, Chronic liver diseases and malnutrition were excluded from the study. Of the total 103 patients, 70 [68%] were males, 33 [32%] were females. Mean age was 9.6 years. There was significant correlation between Insulin like growth factor 1 Level and weight, chronological age, bone age. While there was no correlation between sex and insulin like growth factor 1. There was no correlation between Insulin like growth factor 1 and maximum growth hormone level response by growth hormone stimulation test, the correlation r = 0.56, the p value >0.05. Insulin like growth factor 1 level is not a reliable indicator of growth hormone deficiency and lacks specificity. It can support the diagnosis of growth hormone deficiency, but growth hormone stimulation test is still the gold standard test in highly suspected cases of growth hormone deficiency even with normal level of Insulin like growth factor 1

lnfantile dyskinesia and vitamin B12 deficiency

We report an 11-months old female infant, failure to thrive, developmentally delayed, who presented to Prince Ali hospital in the south of Jordan with chorea involving right side of the face, and right upper limb, found to have megaloblastic anemia due to vitamin B12 deficiency