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Controversies in the diagnosis and management of growth hormone deficiency in childhood and adolescence
  1. P G Murray1,2,
  2. M T Dattani3,4,
  3. P E Clayton1,2
  1. 1Centre for Paediatrics and Child Health, Institute of Human Development, University of Manchester, Manchester, UK
  2. 2Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Central Manchester Foundation Hospitals NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
  3. 3Section of Genetics and Epigenetics in Health and Disease, Genetics and Genomic Medicine Programme, UCL Institute of Child Health, London, UK
  4. 4London Centre for Paediatric Endocrinology and Diabetes, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  1. Correspondence to Dr Philip Murray, 5th Floor Research, Royal Manchester Children's Hospital, Oxford Road, Manchester M13 9WL, UK; Philip.Murray{at}manchester.ac.uk

Abstract

Growth hormone deficiency (GHD) is a rare but important cause of short stature in childhood with a prevalence of 1 in 4000. The diagnosis is currently based on an assessment of auxology along with supporting evidence from biochemical and neuroradiological studies. There are significant controversies in the diagnosis and management of GHD. Growth hormone (GH) stimulation tests continue to play a key role in GHD diagnosis but the measured GH concentration can vary significantly with stimulation test and GH assay used, creating difficulties for diagnostic accuracy. Such issues along with the use of adjunct biochemical markers such as IGF-I and IGFBP-3 for the diagnosis of GHD, will be discussed in this review. Additionally, the treatment of GHD remains a source of much debate; there is no consensus on the best mechanism for determining the starting dose of GH in patients with GHD. Weight and prediction based models will be discussed along with different mechanisms for dose adjustment during treatment (auxology or IGF-I targeting approaches). At the end of growth and childhood treatment, many subjects diagnosed with isolated GHD re-test normal. It is not clear if this represents a form of transient GHD or a false positive diagnosis during childhood. Given the difficulties inherent in the diagnosis of GHD, an early reassessment of the diagnosis in those who respond poorly to GH is to be recommended.

  • Endocrinology
  • Growth

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