Growth is a good indicator of a child's health, and stunting compels the paediatrician to look for the cause. Growth hormone deficiency (GHD) is one of the endocrine causes that leads to growth retardation in children. An accurate diagnosis is crucial for the timely initiation of treatment in order to optimize the child's growth and adult height and avoid comorbidities that affect his/her quality of life.
Multiple GH stimulation tests (GHSTs) have been designed to assess GH sufficiency in children in an attempt to arrive at the more accurate diagnosis of GHD. The use of GHST is standard practice in paediatric patients, generally due to the requirements of health systems, even in children with clearly identifiable risk factors in whom the implementation of GHST could be considered redundant.
In this work, with more than 900 patients, we provide evidence that the diagnosis of growth hormone deficiency can be made with high precision, without the need to resort to GHSTs in children with growth retardation and any of the following risk factors:
- Pituitary dysgenesis on MRI, or
- Two or more pituitary hormone deficiencies (TSH, ACTH, or prolactin), or
- Deficiency of a pituitary hormone (TSH, ACTH, or prolactin) plus one of the following:
- Neonatal hypoglycaemia or hypogonadism
- Central diabetes insipidus
- Midline craniofacial abnormalities (clinical or radiological)
- History of surgery or sellar or suprasellar tumour
- Cranial radiation therapy ≥18 Gy
Clément F
Reference: Clément F, Grinspon RP, Yankelevich D, Martín Benítez S, De La Ossa Salgado MC, Ropelato MG, Ballerini MG, Keselman AC, Braslavsky D, Pennisi P, Bergadá I, Finkielstain GP, Rey RA. Development and Validation of a Prediction Rule for Growth Hormone Deficiency Without Need for Pharmacological Stimulation Tests in Children With Risk Factors. Front Endocrinol. 2021;11:624684. doi: 10.3389/fendo.2020.624684.