Variability in the management of healthy short youth following GH stimulation testing.
Management of short stature in youth following GH testing varies widely, even within a single institution, reflecting differing clinical practices.
Where it sits
this study against the rest of the hgh (somatropin) corpusSummary and findings
The study examined management variability in healthy 8-14 year olds following GH stimulation testing at a single pediatric institution. Participants were grouped by peak GH levels and tracked for treatment decisions over two years. Variability was observed in GH treatment offers, acceptance, and use of other hormonal treatments.
Abstract
<h4>Background/objectives</h4>Recent Delphi survey of endocrinologists revealed low consensus regarding the diagnosis of pediatric growth hormone deficiency (GHD). Thus, we sought to describe the various trajectories undertaken by healthy 8-14 year old youth in the 2 years following testing for GHD at a single major pediatric academic institution.<h4>Methods</h4>Electronic health records were reviewed for the current analysis from healthy 8-14 year old participants enrolled in a prospective longitudinal observational study of parent and youth characteristics associated with youth quality of life and self-esteem over a two-year period following growth hormone (GH) stimulation testing. Participants were grouped according to their peak GH concentration on testing (<7, 7-10, and ≥10 ng/ml), and outcomes included treatment (or not) with GH or other growth-altering hormonal treatments.<h4>Results</h4>Of the 115 participants, 27 (23%) had peak GH <7 ng/ml, 27 (23%) 7-10 ng/ml, and 61 (53%) peaked ≥10 ng/ml. Across the 3 groups, some patients were not offered GH treatment, some were offered yet did not pursue treatment, and some were offered and treated - with further variance provided by GH treatment interruptions, early cessation <i>vs</i> continued GH treatment, delayed GH treatment start, and treatment with other agents (testosterone, gonadotropin releasing hormone agonist, or aromatase inhibitor) either in lieu of or in addition to GH.<h4>Conclusions</h4>Even within the network of a single academic institution, variability is evident in the management of healthy 8-14 year old short youth following GH stimulation testing.
Background
The study addresses the clinical question of how healthy short youth are managed following GH stimulation testing, given the low consensus on pediatric GHD diagnosis. Previous surveys have highlighted variability in practice, making this study relevant to understanding real-world management patterns.
Methods
This was a prospective longitudinal observational study reviewing electronic health records of 115 healthy 8-14 year olds. Participants were grouped by peak GH concentration (<7, 7-10, ≥10 ng/ml) and followed for two years to observe treatment decisions, including GH and other hormonal therapies.
Results
Of the 115 participants, 27 had peak GH <7 ng/ml, 27 had 7-10 ng/ml, and 61 had ≥10 ng/ml. Treatment decisions varied, with some not receiving GH, some receiving but discontinuing early, and others receiving additional hormonal treatments. The variability highlights differing clinical approaches even within a single institution.
Interpretation
The study reveals significant variability in treatment decisions for short stature in youth, which may reflect differing interpretations of GH stimulation test results. While the variability is statistically significant, the clinical significance is less clear due to the lack of standardized treatment protocols. The single-site design limits generalizability.
Key findings
- 115 participants aged 8-14 years were included.
- 23% had peak GH <7 ng/ml.
- 23% had peak GH 7-10 ng/ml.
- 53% had peak GH ≥10 ng/ml.
- Treatment decisions varied widely, including GH and other hormonal agents.
Limitations
- single-site study
- observational design
- no standardized treatment protocol
- limited to healthy short youth
- potential selection bias