Variability in the management of healthy short youth following GH stimulation testing

Recent Delphi survey of endocrinologists revealed low consensus regarding the diagnosis of pediatric growth hormone deficiency (GHD). Thus, we sought to describe the various trajectories undertaken by healthy 8-14 year old youth in the 2 years following testing for GHD at a single major pediatric academic institution.

Electronic health records were reviewed for the current analysis from healthy 8-14 year old participants enrolled in a prospective longitudinal observational study of parent and youth characteristics associated with youth quality of life and self-esteem over a two-year period following growth hormone (GH) stimulation testing. Participants were grouped according to their peak GH concentration on testing (<7, 7-10, and ≥10 ng/ml), and outcomes included treatment (or not) with GH or other growth-altering hormonal treatments.

Of the 115 participants, 27 (23%) had peak GH <7 ng/ml, 27 (23%) 7-10 ng/ml, and 61 (53%) peaked ≥10 ng/ml. Across the 3 groups, some patients were not offered GH treatment, some were offered yet did not pursue treatment, and some were offered and treated - with further variance provided by GH treatment interruptions, early cessation vs continued GH treatment, delayed GH treatment start, and treatment with other agents (testosterone, gonadotropin releasing hormone agonist, or aromatase inhibitor) either in lieu of or in addition to GH.

Even within the network of a single academic institution, variability is evident in the management of healthy 8-14 year old short youth following GH stimulation testing.