This medical condition happens when there is insufficient conversion of GH to IGF-1 by the liver.  To determine IGF-1-deficiency, your doctor will order an IGF-1 blood test, or also known as SM-C/IGF-1, Somatomedin-C, and Sulfation factor. IGF-1 blood test is primarily ordered to check for pituitary gland disorders and to assess abnormalities in growth hormone production.  An IGF-1 blood test is commonly ordered for patients with symptoms of insufficient or excess production of GH and IGF-1. Unlike GH, the levels of IGF-1 are stable throughout the day, making it a significant indicator of average GH levels. 
Several factors can affect the conversion of GH to IGF-1 by the liver, leading to deficient IGF-1 levels. First and foremost, if there is an existing problem in the principal site of GH to IGF-1 conversion which is the liver,  then such conversion may not happen or the liver can only produce little amounts of IGF-1. Also, if there is insufficient amount of GH in the blood, the levels of IGF-1 can fall below the normal. Other factors which can affect IGF-1 levels are pituitary tumors, gene mutations, head injuries or trauma, infections, radiation and surgery.  Also, caloric or protein restriction in the diet can decrease the levels of IGF-1 by decreasing the liver cells’ sensitivity to GH stimulation. 
In children, the following may indicate IGF-1 deficiency: 
In adults, abnormally low levels of IGF-1 may cause subtle, nonspecific symptoms such as: 
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