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Limited Utility of Biochemical Screening for Pituitary Deficiencies and Adverse Effects in Idiopathic GH Deficiency

Stephen Zborovski1, Mark R Palmert1, Jennifer Harrington1

  • 1Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.

Journal of the Endocrine Society
|May 9, 2019
PubMed

Insights

Routine screening for multiple pituitary hormone deficiencies (MPHD) in children with isolated growth hormone (GH) deficiency is rarely necessary. Biochemical screening for MPHD should be reserved for children with an abnormal MRI.

Area of Science:

  • Pediatric Endocrinology
  • Growth Hormone Therapy
  • Pituitary Disorders

Background:

  • Routine biochemical screening for multiple pituitary hormone deficiencies (MPHD) and GH treatment complications is common in children with isolated GH deficiency (GHD).
  • Evidence supporting this practice is limited.

Purpose of the Study:

  • To determine the incidence of MPHD development in children initially diagnosed with isolated GHD.
  • To assess the effectiveness of screening tests in detecting GH therapy complications.

Main Methods:

  • Retrospective analysis of 328 children treated with GH since 2005.
  • Included subjects with GHD, idiopathic short stature, and SHOX deficiency.
  • Excluded subjects with GHD associated with acquired disorders or known pituitary abnormalities.

Main Results:

  • MPHD developed in 4.2% of children with isolated GHD after a mean of 35.4 months.
  • MRI abnormalities were associated with a 6.3-fold increased risk of developing MPHD.
  • Dysglycemia occurred in 0.9% of subjects; no persistent liver or renal function abnormalities were noted.

Conclusions:

  • Routine biochemical screening for MPHD in children with isolated GHD has a limited role.
  • Screening for MPHD should be prioritized for children with abnormal MRI findings.
  • Routine screening for adverse effects of GH therapy is not generally warranted in otherwise healthy children.
Abstract

Keywords:
childrengrowth hormone deficiencymultiple pituitary hormone deficiencyscreening tests

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