Stimulation tests for growth hormone

[participant1]

Was there some sort of changes in GH guidelines back in 2005 or 2006 increasing the number of GH stimulation tests from one to two? I'm seeing more denials of requests with only 1 test

[jacqueline.kostick]

The most recent guidelines which cover the diagnosis and treatment of GH deficiency were released by the Endocrine Society in 2006. Additionally, other guidelines were published by NICE in 2005 and AACE in 2003.

Based on the 3 guidelines, only the NICE guidance specified that a GH deficiency diagnosis should be confirmed by 2 GH provocation tests. Both the Endocrine Society and AACE did not state a particular threshold for the number of provocative tests; however, specific exceptions were described in each guideline:

• The Endocrine Society states that the presence of 3 or more deficiencies of the pituitary axes strongly suggests the presence of GHD, and in this context provocative testing is optional.
  
• NICE only requires 1 GH test in children with defined CNS pathology, a history of irradiation, multiple pituitary hormone deficiency (MPHD) or a genetic defect affecting the GH axis.
  
• AACE states that the combination of complete hypopituitarism and a low IGF-I concentration is sufficient evidence to approve the use of GH therapy; therefore, the need for dynamic testing is eliminated.

Sources
1. The Endocrine Society. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. Chevy Chase, MD: Endocrine Society; 2006. Available at the following link Accessed August 7, 2008.

2. NHS. National Institute for Clinical Excellence. Guidance on the use of growth hormone (somatropin) in children with growth failure. June 2005. Available at the following link Accessed August 7, 2008.

3. AACE. Medical guidelines for clinical practice for growth hormone use in adults and children, 2003 update. Available at the following link Accessed August 7, 2008.