Survey of growth hormone treatment practices by 251 pediatric endocrinologists

We wished to determine current GH treatment practices of pediatric endocrinologists and to see whether those practices related to physician characteristics. We analyzed questionnaires completed by 251 of 413 (61%) pediatric endocrinologists attending a national meeting focused on growth research. In general, laboratory testing is little used in deciding to begin or to end GH therapy. Auxological criteria account for 6 of 8 decision items always used by more than 50% of physicians for starting GH treatment and for 5 of 6 items always used for stopping therapy. Although 80% of respondents use 2 GH stimulation tests, only 32% believe such tests predict the response to therapy, 40% do not know which type of assay their lab uses, and 82% use GH in short, poorly growing children regardless of stimulation tests results. Ten percent treat short, normally growing children who pass GH stimulation tests. The median number of syndromes treated off-label was 6. There were no striking differences between faculty and private practitioners in the use of laboratory screening tests, in the use of auxological or laboratory criteria, in perceptions of risk of therapy, or in the number of syndromes treated, nor were there significant differences based on practice volume. Respondents support growth screening in schools and guidelines for the uniform use of GH treatment. Despite the ambiguities and controversies in current GH therapy, pediatric endocrinologists share many diagnostic and therapeutic philosophies.