Growth Hormone Stimulation Testing Patterns Contribute to Sex Differences in Pediatric Growth Hormone Treatment

Area of Science:

• Pediatric endocrinology
• Growth disorders
• Medical decision-making

Background:

• Males are twice as likely as females to receive pediatric growth hormone (GH) treatment in the USA.
• Male predominance in evaluation and referral for short stature contributes to this disparity.
• This study investigates if sex differences in GH testing and prescription further contribute to male predominance.

Purpose of the Study:

• To investigate sex differences in growth hormone (GH) stimulation testing and GH prescription rates.
• To determine if these differences contribute to the male predominance in pediatric GH treatment.
• To explore the influence of sex bias on medical decision-making for short stature.

Main Methods:

• Retrospective chart review of 10,125 children (aged 2-16) evaluated for short stature or poor growth.
• Analysis of sex differences in GH stimulation testing and GH prescription using logistic regression.
• Examination of predictor variables for testing and prescription by sex.

Main Results:

• Fewer females (35%) were evaluated for short stature compared to males.
• Males were more likely to undergo GH stimulation testing (13.1% vs. 10.6%) at less severe height z-scores.
• GH prescription rates were similar by stimulated peak GH level, but predictors differed by sex.

Conclusions:

• Sex differences in GH stimulation testing rates, not test response, contribute to male predominance in pediatric GH treatment.
• Height z-score predicted GH prescription in females but not males, suggesting potential sex bias in decision-making.
• Further research is needed to understand the role of sex bias versus objective data in short stature treatment.