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
...And Diagnosis of Growth Hormone Deficiency...
...GH Provocative Testing is Not Required to Diagno...
...note, for patients who do not meet the follow...
...Pediatric Endocrine Society (PES) suggests esta...
...ggests that GHD due to congenital hypopituitaris...
GH Provocative Testing
The PES recommends against reliance on GH pr...
...iven the large discrepancies between GH assays, t...
...sts sex steroid priming prior to provoca...
...t of Spontaneous GH Secretio...
...he PES recommends against the use of...
Treatment
...reatment...
...icacy of GH Treatment for GHD
...S recommends the use of GH to normalize...
...suggests against routine cardiac testing, d...
...ng of GH Treatment for Patients With GH...
...recommends the use of weight-based...
...ES recommends an initial GH dose of...
The PES suggests measurement of serum IGF...
...g puberty, the PES recommends against the routine...
...ecommends that GH treatment at pediatric...
...sues of GH Treatment for Patients With GHD...
...recommends that prospective recip...
...ends monitoring of GH recipients for potential dev...
...mmends re-assessment of both the adr...
The PES recommends discussion about...
...PES recommends counseling prospective recip...
The PES recommends informing at-risk patients abou...
...dren with acquired GHD due to effec...
...e initiation of GH treatment, the P...
...ation after completion of tumor thera...
...e rare situation where a child with GHD has an...
...ildren considered not to be at risk, t...
...mmends that prospective recipients of GH tre...
Transitional Care After Childhood GH Tr...
...nds that patients with multiple (≥3)...
...mmends re-evaluation of the somatotropic a...
...ests that measurement of the serum IGF-I concent...
...ecommends GH provocative testing t...
...that GH treatment be offered to individuals wi...
...of Patients With Idiopathic Short Statu...
...U.S.A., for children who meet FDA criteria, th...
...PES suggests a follow-up assessment...
...ere is overlap in response between dosing groups...
...Treatment of Patients With Primary IGF-I Def...
...mends the use of IGF-I therapy to increase heig...
...e of a single “best” test that p...
...he PES recommends a trial of GH th...
...gests an IGF-I dose of 80–120 μg/kg...
...e PES recommends administration of IG...
...neral Recommendatio...
...he PES recommends that physicians with exper...
...PES recommends further study of the unre...