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

...iagnos...

...onsideration And Diagnosis of Growth Hormone De...

...ons Where GH Provocative Testing is Not Required...

..., for patients who do not meet the followi...

...Endocrine Society (PES) suggests establi...

...ES suggests that GHD due to congenital hyp...

GH Provocative Testi...

...PES recommends against reliance on GH provoc...

Given the large discrepancies between GH assays, t...

...ES suggests sex steroid priming prior t...

...of Spontaneous GH Secretion

...ecommends against the use of spontaneous GH se...


Treatment

Treatment

...ficacy of GH Treatment for GHD...

...commends the use of GH to normalize adult height...

...S suggests against routine cardiac testing,...


...osing of GH Treatment for Patients With...

...recommends the use of weight-based or body su...

...mends an initial GH dose of 0.16–0.24 m...

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

...erty, the PES recommends against the...

...nds that GH treatment at pediatric doses...


...of GH Treatment for Patients With...

...PES recommends that prospective re...

...ds monitoring of GH recipients for potentia...

The PES recommends re-assessment of both...

...ecommends discussion about and monitoring of glu...

...commends counseling prospective recipients of...

The PES recommends informing at-ri...

For children with acquired GHD due to...

...fore initiation of GH treatment, the PES recomm...

...H initiation after completion of tu...

...rare situation where a child with GHD...

...ldren considered not to be at risk, the...

...e PES recommends that prospective re...


...nal Care After Childhood GH Treatme...

...e PES recommends that patients with multiple (...

...ommends re-evaluation of the somatotropic...

...ests that measurement of the serum IG...

...recommends GH provocative testing to e...

...s that GH treatment be offered to...


...tment of Patients With Idiopathic Short...

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

...ts a follow-up assessment of benefit i...

...se there is overlap in response between dos...


...Treatment of Patients With Primary IGF-...

...ends the use of IGF-I therapy to increase h...

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

The PES recommends a trial of GH t...

...an IGF-I dose of 80–120 μg/kg bid. S...

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


...Recommendations...

...PES recommends that physicians with expertise in...

...mends further study of the unresolved issues h...