Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-like Growth Factor-I Deficiency

Publication Date: January 1, 2017

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

...Diagnosis

...Consi...

...Conditions Wh...

...atients who do not meet the followi...

...iatric Endocrine Society (PES) suggests estab...

...gests that GHD due to congenital hypopituitarism b...

...GH...

...ds against reliance on GH provocative test r...

...large discrepancies between GH assays, the PES...

...PES suggests sex steroid priming prior to...

...M...

...recommends against the use of spontaneous...


Treatment

...Treatment...

...Efficacy of GH...

...ecommends the use of GH to normalize a...

...PES suggests against routine cardiac test...


...Dosin...

...he PES recommends the use of weight-ba...

...S recommends an initial GH dose of 0.16...

...e PES suggests measurement of serum IGF-I...

...puberty, the PES recommends against...

...S recommends that GH treatment at pedi...


...Safety Issues of...

...ds that prospective recipients of GH tre...

...ends monitoring of GH recipients for poten...

...recommends re-assessment of both th...

...PES recommends discussion about and...

...ommends counseling prospective recipients of GH...

...mmends informing at-risk patients about avail...

...n with acquired GHD due to effects...

...tion of GH treatment, the PES recommends sha...

...r GH initiation after completion of tumor t...

...the rare situation where a child with GH...

...children considered not to be at ri...

...recommends that prospective recipient...


...Transitiona...

...ds that patients with multiple (≥3) pituitar...

...recommends re-evaluation of the somatotropic...

The PES suggests that measurement of...

The PES recommends GH provocative testi...

...sts that GH treatment be offered to...


...GH...

...n the U.S.A., for children who meet FDA criter...

...ggests a follow-up assessment of benefit in hei...

Because there is overlap in response betwee...


...IGF-I Treat...

...PES recommends the use of IGF-I therapy to inc...

...e of a single “best” test that predicts r...

...PES recommends a trial of GH therapy before...

The PES suggests an IGF-I dose of 8...

...S recommends administration of IGF-I...


...Gener...

...recommends that physicians with expertise i...

...recommends further study of the u...