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
Diagno...
...eration And Diagnosis of Growth Hor...
...Where GH Provocative Testing is Not Required to...
Of note, for patients who do not meet the...
...e Pediatric Endocrine Society (PES) suggests...
...PES suggests that GHD due to congenital h...
...Provocative Tes...
...nds against reliance on GH provocative test res...
...large discrepancies between GH assays, th...
...ES suggests sex steroid priming pri...
...rement of Spontaneous GH S...
The PES recommends against the use of spontan...
Treatment
...atment
...of GH Treatment for GHD...
...recommends the use of GH to normalize...
...PES suggests against routine cardiac te...
...of GH Treatment for Patients With...
...e PES recommends the use of weight-based o...
...S recommends an initial GH dose of 0.16–0.24 mg/...
...gests measurement of serum IGF-I levels as...
...rty, the PES recommends against the...
...PES recommends that GH treatment at...
...fety Issues of GH Treatment for Patients With GHD...
The PES recommends that prospective recipie...
...he PES recommends monitoring of GH recipients...
...recommends re-assessment of both the adr...
...ends discussion about and monitoring of glu...
...nds counseling prospective recipients of GH trea...
...PES recommends informing at-risk patients about...
...th acquired GHD due to effects of a...
...e initiation of GH treatment, the PES recommends...
...on after completion of tumor therapy with no evide...
...are situation where a child with GHD has an accomp...
...ldren considered not to be at risk,...
...S recommends that prospective recipients...
...itional Care After Childhood GH Treatment...
...ommends that patients with multiple (≥3)...
...e PES recommends re-evaluation of the...
...gests that measurement of the serum IGF...
...PES recommends GH provocative testing to e...
...uggests that GH treatment be offered to individual...
...Treatment of Patients With Idiopathic Short Statu...
...for children who meet FDA criteria, the PES...
...PES suggests a follow-up assessment of benefit...
...e is overlap in response between dosing groups,...
...nt of Patients With Primary IGF-I Deficien...
...ds the use of IGF-I therapy to increase height i...
...he absence of a single “best” test...
...ommends a trial of GH therapy before ini...
...an IGF-I dose of 80–120 μg/kg bid. Similar...
The PES recommends administration of I...
...eneral Recommendations...
...ommends that physicians with exper...
The PES recommends further study of the...