Evolving growth hormone deficiency: proof of concept

Area of Science:

• Pediatric Endocrinology
• Growth and Development
• Hormone Physiology

Background:

• Persistent growth failure in children necessitates accurate diagnosis and management.
• Growth Hormone Deficiency (GHD) is a key consideration in pediatric short stature.
• The diagnostic utility of repeat Growth Hormone Stimulation Tests (GST) in evolving GHD requires further investigation.

Purpose of the Study:

• To investigate the evolution of Growth Hormone Deficiency (GHD) in adolescent males with persistent growth failure.
• To determine the diagnostic value of a second Growth Hormone Stimulation Test (GST) in identifying evolving GHD.
• To analyze the impact of Growth Hormone (GH) therapy on final adult height in this cohort.

Main Methods:

• Retrospective chart review of pediatric patients with short stature or growth failure.
• Inclusion criteria: two Growth Hormone Stimulation Tests (GSTs) performed.
• Data analysis included height, IGF-1 levels, and GH peak responses.

Main Results:

• 42 out of 53 patients were males; average initial GH peak was 15.48 ng/ml.
• Height SDs decreased over time, and IGF-1 levels remained low.
• Repeat GST showed lower GH peaks (7.59 ng/dL), with 36% ≤7 ng/dl; 12 males achieved significant height gain with GH therapy.

Conclusions:

• Evidence supports the concept of Evolving Growth Hormone Deficiency (EGHD) identified through repeat GST.
• Persistent growth slowdown, even with pubertal progression, warrants careful longitudinal follow-up.
• Repeat GST is essential for accurate diagnosis of GHD in children with persistent growth failure.