Sex steroid priming in short stature children unresponsive to GH stimulation tests: Why, who, when and how

Area of Science:

• Pediatric Endocrinology
• Growth Hormone Therapy
• Diagnostic Challenges

Background:

• Growth hormone deficiency (GHD) diagnosis in peripubertal children is complex, often relying on growth hormone stimulation tests (GHSTs).
• Controversies persist regarding the number and interpretation of GHSTs, leading to diagnostic uncertainty.
• Short children with slow growth and delayed puberty may show transiently low GHST peaks, risking misdiagnosis and overtreatment.

Purpose of the Study:

• To review the clinical use of sex steroid priming before GHSTs in peripubertal children.
• To highlight the need for standardized guidelines for sex steroid priming in GHD diagnosis.
• To address diagnostic pitfalls and optimize GHST interpretation in this age group.

Main Methods:

• Review of existing literature on sex steroid priming and GHSTs in pediatric GHD diagnosis.
• Analysis of the interplay between GH axis and sex steroids in peripubertal development.
• Discussion of current controversies and potential solutions for diagnostic challenges.

Main Results:

• Sex steroid priming may enhance GHST sensitivity in peripubertal children, potentially improving diagnostic accuracy.
• Current practices lack consensus on patient selection, timing, dosage, and preparation of sex steroids for priming.
• Transient suboptimal GHST responses can normalize with puberty, complicating diagnosis without appropriate interventions.

Conclusions:

• Standardized guidelines for sex steroid priming are crucial to overcome diagnostic challenges in peripubertal GHD.
• Appropriate use of sex steroid priming could reduce GHD overtreatment and associated health and economic burdens.
• Further research is needed to establish optimal protocols for sex steroid priming in pediatric GHD diagnosis.