Table 5 Comparison of published clinical practice guidelines, survey responses, and NCGS registry data.

Height SD prompting evaluation of GHD

, 2.2, 2 SD plus GV 1 S1.5 SD than MP2 SD than MP

3 SD 88%2 SD 82%1.5 SD below MPH 87%

At start of treatment 2 SD 75%

Is GHST necessary to make diagnosis of GHD?

GHST 10 mcg/L plus IGF-1 2 SD important for diagnosi. GHST optional if structural pituitary lesion, surgery, radiation, or MPH.

GHST should always be performed (29%).

In presence of structural abnormality or pituitary insult plus low IGF-1, GHST not necessary (33%).

Recorded GHST

All Patients 1987–2005 70% 2000–2005 53%

OGHD Patients 1987–2005 74% 2000–2005 49%

If not required by insurance would you continue to perform GHST?

Important for diagnosis of GH.

55% would still perform GHST

N/A

Value of IGF-1 in diagnosis of GHD

2 SD require.

2 SD strongly suggestiv.

GHD unlikely if IGF-1 ≥0 S.

Low IGF-1 in absence of disease and malnutrition equivalent (45%) or better (37%) than GHST.

Recorded IGF-11987–2005 24% 2000–2005 41%IGF-1 sole diagnostic tool recorded in 4%–6%

Routine monitoring of IGF-1 on GH therapy

Monitoring of IGF-1 is usefu.

Yearly monitoring of IGF-1 is usefu.

If IGF-1 2 SD after first two years of therapy, GH dose reduction should be considere.

72% endorse routine monitoring of IGF-1.

Growth response (85%) and weight gain (80%) were more commonly endorsed as basis of GH dose adjustments than IGF-1 targets (55%–62%).

86% endorsed use of IGF-1 to guide GH dose increase if growth response is poor.

41% have IGF-1 recorded at least annually (2000–2005).

GH dose was more likely to be increased in ISS patient growing poorly in the first year of therapy if IGF-1 was measured.

No impact of IGF-1 measurement on GH dose increase in IGHD or OGHD poor responders.

Assessing response to GH therapy

Height should increase 0.25 SD in first yea.

GH dose increase may be considered if compliance and other causes of poor growth eliminate.

Poor response criteria (% agree)

0.25 Height SD (78%)GV increase of 2 cm/yr (85%)

50% GV increase (77%)

Poor response rate0.25 Height SD (13%)

GV increase of 2 cm/yr (11%)50% GV increase (16%)

No dose change made in 40% of poor responders (IGHD or OGHD).

Use of Pubertal dosing

GH at a dose of 0.7 mg/kg/wk increased near adult height by 4 cm (0.7 SD) compared to 0.3 mg/kg/wk dos.

Pubertal dosing should be used:

in all GHD patients (35% agree);

only in patients not expected to reach target height (59% agree)

GH Dose during puberty 0.4 mg/kg/wk 37% 0.6 mg/kg/wk 10%

Height 2 SD was not more common among those receiving these higher GH doses.

Transition evaluation

Repeat GHST not necessary if MPHD, severe organic GHD, or genetic defect.

Re-evaluate with GHS and IGF- 1–3 months after stopping GH.

In children with MPHD GH need not be discontinued (84% agree); would resume GH with finding of low IGF-1 alone after stopping GH therapy for at least a month (55% agree).

N/A