22798 Insulin-Like Growth Factor Binding Protein 3 (IGFB3)

​Insulin-like growth factor 1 (IGF-1) and insulin-like growth factor-binding protein 3 (IGFBP-3) reference ranges are highly age dependent and results must always be interpreted within the context of the patient's age.

Discrepant IGFBP-3 and IGF-1 results can sometimes occur due to liver and kidney disease; however, this is uncommon and such results should alert laboratories and physicians to the possible occurrence of a preanalytical or analytical error.

At this time, IGFBP-3 cannot be reliably used as a prognostic marker in breast, colon, prostate, or lung cancer.

IGFBP-3 assays exhibit significant variability among platforms and manufacturers. Direct comparison of results obtained by different assays is problematic. Reestablishing a patient's-baseline concentration is preferred if assays are changed.

Heterophilic antibodies in human serum can react with the immunoglobulins included in the assay components causing interference with in vitro immunoassays. Specimens from patients with autoimmune diseases or from individuals routinely exposed to animals or animal serum products can demonstrate this type of interference, potentially causing an anomalous result. The assay reagents have been formulated to minimize the risk of such interference; however, potential interactions between rare sera and test components can occur. For diagnostic purposes, the results obtained from this assay should always be used in combination with the clinical examination, patient medical history, and other findings.

​Insulin-like growth factor-binding protein 3 (IGFBP-3) is a 264-amino acid peptide (molecular weight 29 kDa) produced by the liver. It is the most abundant of a group of IGFBPs that transport, control bioavailability and half-life of the insulin-like growth factors (IGF), in particular IGF-1, the major mediator of the anabolic- and growth-promoting effects of growth hormone (GH). Noncomplexed IGFBP-3 and IGF-1 have short half-lives (t1/2) of 30 to 90 minutes and 10 minutes, respectively, while the IGFBP-3/IGF-1 complex is cleared with a much slower t1/2 of 12 hours. In addition to its IGF-binding function, IGFBP-3 also exhibits intrinsic growth-regulating effects that are not yet fully understood but have evoked interest with regards to a possible role of IGFBP-3 as a prognostic tumor marker.

The secretion patterns of IGFBP-3 and IGF-1 mimic each other; their respective syntheses are primarily controlled by GH. Unlike GH secretion, which is pulsatile and demonstrates significant diurnal variation, IGFBP-3 and IGF-1 levels show only minor fluctuations. IGFBP-3 and IGF-1 serum levels therefore represent a stable and integrated measurement of GH production and tissue effect.

Low IGFBP-3 and IGF-1 levels are observed in GH deficiency or GH resistance. If acquired in childhood, these conditions result in short stature. Childhood GH deficiency can be an isolated abnormality or associated with deficiencies of other pituitary hormones. Some of the latter cases may be due to pituitary or hypothalamic tumors, or result from cranial radiation or intrathecal chemotherapy for childhood malignancies. Most GH resistance in childhood is mild to moderate, with causes ranging from poor nutrition to severe systemic illness (eg, renal failure). These individuals may have IGF-1 and IGFBP-3 levels within the reference range. Severe childhood GH resistance is rare and usually due to GH-receptor defects. Both GH deficiency and mild-to-moderate GH resistance can be treated with recombinant human GH (rhGH) injections. The prevalence and causes of adult GH resistance are uncertain, but adult GH deficiency is seen mainly in pituitary tumor patients. It is associated with decreased muscle bulk and increased cardiovascular morbidity and mortality, but replacement therapy remains controversial.

Elevated serum IGFBP-3 and IGF-1 levels indicate a sustained overproduction of GH or excessive rhGH therapy. Endogenous GH excess is caused mostly by GH-secreting pituitary adenomas, resulting in gigantism, if acquired before epiphyseal closure, and in acromegaly thereafter. Both conditions are associated with generalized organomegaly, hypertension, diabetes, cardiomyopathy, osteoarthritis, compression neuropathies, a mild increase in cancer risk, and diminished longevity. It is plausible, but unproven, that long-term rhGH-overtreatment may result in similar adverse outcomes.