PAPP-A (pregnancy-associated plasma protein A) is a zinc metalloproteinase in the insulin-like growth factor system that is expressed by tissues outside of pregnancy and involved in normal and dysregulated growth. It has prognostic impact in pregnancy and acute coronary syndrome. PAPP-A regulate the activity of insulin-like growth factor (IGF) signal pathway through proteolytic degradation of IGF binding proteins (IGFBPs) thereby increasing the local concentration of free IGFs available to receptors. PAPP-A levels is associated with abnormal glucose metabolism and increased risk of atherosclerosis in AGHD (Adult Growth Hormone Deficiency) patients.