Growth hormone isoforms and segments/fragments: Molecular structure and laboratory measurement

Endocrine diagnostic tests are dependent on the molecular characteristics of protein hormones, a property that is also intimately tied to function. The structure–function relationship is of particular importance for multifunctional protein hormones such as growth hormone (GH). For clinical diagnosis, it is imperative to understand the relationship between GH structure (and its molecular fragments) and function and their potential interaction with single or multiple receptors. The existence of a single or aggregated intact GH 22 kDa form such as the 20 kDa GH isoform has been described, but GH fragments cannot be excluded a priori. Recent advances and probable similarity of GH with other protein hormones such as natriuretic peptides (ANP, BNP and their proANP and proBNP fragments) and POMC (ACTH, β-endorphin, etc.) lend support to the hypothesis that GH fragments should also be present. This brief review focuses on GH heterogeneity and feasible post-synthesis events. The aim of the review is to describe which GH forms/fragments have already been recognized and/or are potentially present in the circulation. The impacts of GH isoforms (namely the intact 20 and 22 kDa isoforms) and fragments thereof on quantitative measurement are discussed with reference to traditional immunoassay technology and innovative immunofunctional laboratory assays.