Evaluation of Growth Hormone Stimulation Testing in Children

Abstract

Objective

To evaluate the use and interpretation of growth hormone (GH) stimulation tests used across the UK for diagnosing GH deficiency.

Background

Previous studies show poor consensus on the use of GH stimulation tests. Sex steroid priming and retesting in the transition period are areas not previously surveyed.

Design

Data were collected from tertiary paediatric endocrinologists, paediatricians with a specialist interest in endocrinology, and biochemists across the UK over six months through distributing electronic surveys.

Results

At least three different GH stimulation tests were used by 33% of departments. Glucagon and insulin doses varied most, and sampling frequency varied most using insulin. All laboratories use a recommended chemiluminescence immunoassay with an acceptable coefficient of variability. The GH peak for diagnosing GH deficiency varied from 6μg/L to 8μg/L. A wide range of clinical scenarios prompted retesting in the transition period, suggesting non-standardised current practice. Seventy-five percent of departments use sex steroid priming, but follow criteria variously combining bone age, chronological age and pubertal stage, together with variations in steroid type and dose.

Conclusions

Although a contentious diagnostic test, GH stimulation tests remain the gold standard for diagnosing GH deficiency. Our data suggest that together with variation in indication, protocol and interpretation, there is considerable variation in current practices pertaining to priming and retesting in transition. Given the current financial climate and the need for careful resource management, this study emphasises the considerable need for consensus in the investigation, diagnosis and long-term follow-up of these children, at least nationally if not internationally.

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