Endocrine disorders

Guidelines: The Pediatric Endocrine Society Publish Guidelines for Growth Hormone Deficiency in Children

The Pediatric Endocrine Society has published updated guidance for treating children with growth hormone deficiency.

The recommendations come as an update to the 2003 guidelines after an extensive literature review process was performed using the GRADE approach. The final update includes 12 conditional and 16 strong recommendations, as well as 10 ungraded good practice statements.

Among the 16 strong recommendations are:

  • Growth hormone should be used to normalize adult height and to avoid extreme shortness in children and adolescents.
  • Do not rely on results of a growth hormone provocative test as the sole diagnostic criterion of growth hormone deficiency.
  • Do not use spontaneous growth hormone secretion for diagnosing growth hormone deficiency.
  • Weight-based or body surface area-based growth hormone dosing should be used for children.
  • An initial growth hormone dose of 0.16 to 0.24 mg/kg/week (22-35 µg/kg/day) is recommended with individualization of subsequent dosing. During puberty, do not routinely increase the growth hormone dose to 0.7 mg/kg/week in every child.
  • Growth hormone treatment at pediatric doses should not continue beyond attainment of a growth velocity below 2.0 to 2.5 cm/year. An individualized treatment approach should be taken to decide whether to discontinue pediatric dosing prior to attainment of this growth velocity.

 

“The taskforce suggests that the recommendations be applied in clinical practice with consideration of the evolving literature and the risks and benefits to each individual patient. In many instances, careful review highlights areas that need further research,” the authors concluded.

—Amanda Balbi

Reference:

Grimberg A, DiVall SA, Polychronakos C, et al; Drug and Therapeutics Committee and Ethics Committee of the Pediatric Endocrine Society. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-1 deficiency. Horm Res Paediatr. 2016;86(6):361-397. https://doi.org/10.1159/000452150