Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-like Growth Factor-I Deficiency
Key Points
Key Points
- The strongest recommendations, reflecting high quality of supporting evidence, were:
- Growth hormone deficiency (GHD)
- Growth hormone (GH) should be used to normalize adult height and avoid extreme shortness in children and adolescents with GHD
- GH provocative test results should not be relied on as the sole diagnostic criterion of GHD
- GH assays should be harmonized
- GH recipients should be monitored regularly for potential development of intracranial hypertension, slipped capital femoral epiphysis (SCFE), and scoliosis progression
- Primary IGF-I deficiency (PIGFD)
- Insulin-like growth factor (IGF-I) therapy should be used to increase height in patients with severe PIGFD.
- Safety monitoring during treatment with IGF-I should include the risk for hypoglycemia.
- All other recommendations, including those for treating idiopathic short stature, received weaker recommendations due to uncertainty about the supporting evidence.
- Important evidence gaps persist related to diagnostic limitations, appropriate outcome measures, and long-term post-treatment safety of GH treatment.
Also discussed in the guideline:
- The balance of benefit, risk, and cost of GH treatment
- The expansion of use of growth-promoting treatment
- Conclusions and future directions
Diagnosis
...agnosis
...And Diagnosis of Growth Hormone Deficiency (G...
...ns Where GH Provocative Testing is Not R...
..., for patients who do not meet the following cri...
...docrine Society (PES) suggests establis...
...PES suggests that GHD due to congenit...
GH Provocative Te...
The PES recommends against reliance on GH p...
...large discrepancies between GH assays, the...
...uggests sex steroid priming prior to provocative...
...asurement of Spontaneous GH Secr...
The PES recommends against the use...
Treatment
...reatme...
...y of GH Treatment for GHD...
...PES recommends the use of GH to normal...
...ES suggests against routine cardiac...
...Treatment for Patients With GHD...
...S recommends the use of weight-based or...
...mends an initial GH dose of 0.16–0.24...
...he PES suggests measurement of serum...
...ing puberty, the PES recommends against the r...
...ecommends that GH treatment at pediatri...
...Issues of GH Treatment for Patients With GHD...
...mends that prospective recipients of GH trea...
...PES recommends monitoring of GH recipie...
...ds re-assessment of both the adrenal and...
...recommends discussion about and monitoring of...
...recommends counseling prospective recipie...
...nds informing at-risk patients about available da...
...h acquired GHD due to effects of a primary m...
...initiation of GH treatment, the PES rec...
...iation after completion of tumor th...
...tuation where a child with GHD has an accompany...
...ren considered not to be at risk, the PES reco...
...commends that prospective recipient...
...al Care After Childhood GH Treatmen...
...ommends that patients with multiple (≥3) pitu...
...e PES recommends re-evaluation of the somat...
...ts that measurement of the serum IGF-I concentrati...
...mends GH provocative testing to evaluate the...
...ts that GH treatment be offered to individuals...
GH Treatment of Patients With Idiopathic Sho...
...., for children who meet FDA criteria, the PES s...
...gests a follow-up assessment of benefit in hei...
...there is overlap in response between dosi...
...t of Patients With Primary IGF-I Deficiency (PIGFD...
...he PES recommends the use of IGF-I therapy...
...the absence of a single “best” test th...
...commends a trial of GH therapy before in...
...sts an IGF-I dose of 80–120 μg/...
...S recommends administration of IGF-I 20 min...
...ral Recommendati...
...recommends that physicians with expert...
...nds further study of the unresolved issue...