Aim To undertake a survey of UK paediatric endocrinologists to assess the current practice for sex steroid priming prior to growth hormone stimulation tests (GHST).
Methods An online questionnaire was sent to Paediatric Endocrinology centres in the UK assessing their current practice of priming for GHST.
Results 26 responses were received from 24 centres with 18/24 (67%) of responses from tertiary endocrine centres and 8/24 (33%) responses from district general hospitals. The agents used for growth hormone stimulation included insulin 15/26 (58%), clonidine 5/26 (19%), arginine 14/26 (54%), glucagon 24/26 (92%) and GnRH/arginine 2/26 (8%). 13/26 (50%) used the cut-off of 6.7ug/l for diagnosis. 85% (22/26) use sex steroid priming. The regimes used for priming are shown in Table 1. Some respondents used more than one regime.
The criteria to prime boys was pre-pubertal with a bone age (BA) >10 years (8/22 (36%)) or chronological age (CA) of >10years (4/22 (18%)). 4 (18%) used either BA or CA and 6/22 (27%) had a practice different to this. The criteria to prime girls was pre-pubertal with a BA >10 years (8/22 (36%)) or CA >10 years (5/22 (23%)). 1/22 (5%) used either BA or CA and 8/22 (36%) had practice different to this.
Conclusion Sex steroid priming is still a controversial area of paediatric endocrinology and there is no clear consensus on how this is undertaken. There appears to be a wide variation in practice in terms of the selection of patients and the drugs and methods used for priming. A consensus guideline on appropriate sex steroid priming prior to GHST will minimise the variation in the diagnosis of growth hormone deficiency.
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