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
...iagnosis...
...eration And Diagnosis of Growth Hormone Deficie...
...onditions Where GH Provocative Tes...
...ients who do not meet the following...
...tric Endocrine Society (PES) suggests establis...
...S suggests that GHD due to congenital hypo...
...ovocative Testing...
...ds against reliance on GH provocativ...
...discrepancies between GH assays, the PES reco...
...S suggests sex steroid priming prior to provocat...
...surement of Spontaneous GH Secretion...
...ecommends against the use of spontan...
Treatment
...reatment
...icacy of GH Treatment for GHD...
...recommends the use of GH to normalize a...
...suggests against routine cardiac testing, dual x-...
...f GH Treatment for Patients With...
...nds the use of weight-based or body surface...
...mends an initial GH dose of 0.16–0.24 mg/kg/wee...
The PES suggests measurement of serum I...
..., the PES recommends against the routi...
...recommends that GH treatment at pediatric...
...Issues of GH Treatment for Patients With GHD...
...ecommends that prospective recipients of GH trea...
...mends monitoring of GH recipients fo...
...e PES recommends re-assessment of both the a...
...recommends discussion about and monitoring of g...
...ends counseling prospective recipients of GH tre...
...PES recommends informing at-risk pati...
...ldren with acquired GHD due to effects of a...
...ion of GH treatment, the PES recommends...
...ion after completion of tumor therapy with...
...ation where a child with GHD has an accompanying...
...nsidered not to be at risk, the PES...
...nds that prospective recipients of GH trea...
...al Care After Childhood GH Treatm...
...S recommends that patients with multiple (...
...recommends re-evaluation of the somatotropic axi...
...uggests that measurement of the serum IGF-I...
...ends GH provocative testing to evaluate...
...s that GH treatment be offered to individu...
...of Patients With Idiopathic Short...
...e U.S.A., for children who meet FDA crit...
...a follow-up assessment of benefit i...
...is overlap in response between dosing group...
...nt of Patients With Primary IGF-I Deficiency...
...commends the use of IGF-I therapy to incr...
...en the absence of a single “best” test...
The PES recommends a trial of GH thera...
...s an IGF-I dose of 80–120 μg/kg bid. Sim...
...ends administration of IGF-I 20 minutes after a...
...Recommendations
...ecommends that physicians with exper...
...PES recommends further study of the unres...