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

...Conside...

...Conditions...

...f note, for patients who do not meet the f...

...c Endocrine Society (PES) suggests establis...

...gests that GHD due to congenital h...

...GH Provocative...

...nds against reliance on GH provocative test re...

...e large discrepancies between GH assays...

...S suggests sex steroid priming prior...

...Measurement of Spon...

...commends against the use of spontane...


Treatment

...Treatmen...

...Efficacy of GH Tr...

...recommends the use of GH to normali...

...uggests against routine cardiac testing, dua...


...Dosing...

...recommends the use of weight-based...

...PES recommends an initial GH dose of...

...ggests measurement of serum IGF-I levels...

...y, the PES recommends against the routine...

...ES recommends that GH treatment at pedi...


...ecommends that prospective recipient...

...S recommends monitoring of GH recipients for pote...

...PES recommends re-assessment of both the...

...ecommends discussion about and monitor...

...ommends counseling prospective recipients of...

...recommends informing at-risk patients ab...

...children with acquired GHD due to effe...

Before initiation of GH treatment, the PES...

...n after completion of tumor therapy w...

...are situation where a child with GHD has an accomp...

For children considered not to be at r...

...he PES recommends that prospective rec...


...he PES recommends that patients with multi...

...recommends re-evaluation of the somatotro...

...sts that measurement of the serum IGF...

...nds GH provocative testing to evaluate the func...

...ests that GH treatment be offered...


...GH Treatment of Patient...

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

...gests a follow-up assessment of be...

Because there is overlap in response...


...ecommends the use of IGF-I therapy...

...ce of a single “best” test that predict...

...ends a trial of GH therapy before init...

...PES suggests an IGF-I dose of 80–120 ...

...ecommends administration of IGF-I 20...


...General Recomm...

...commends that physicians with expertise in managi...

...e PES recommends further study of the unres...