New Guidelines Issued on Treating Children with Growth Failure

The focus was on the diagnoses of idiopathic short stature, growth hormone deficiency, and primary IGF-I deficiency
The focus was on the diagnoses of idiopathic short stature, growth hormone deficiency, and primary IGF-I deficiency

The Drug and Therapeutics, and Ethics Committees of the Pediatric Endocrine Society have updated the 2003 guideline for growth hormone and insulin-like growth factor-I (IGF-I) treatment in children and adolescents. The full guidelines are published in Hormone Research and Paediatrics

The task force focused on the diagnoses of idiopathic short stature (ISS), growth hormone deficiency (GHD), and primary IGF-I deficiency as "diagnostic challenges often blur the distinction" between these conditions. For the first time, recombinant IGF-I therapy has been added to the growth hormone guidelines. The guideline contains recommendations for the clinical management of children and adolescents with growth failure from GHD, ISS, or primary IGF-I deficiency based on best available evidence. 

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Adda Grimberg, MD, pediatric endocrinologist at Children's Hospital of Philadelphia (CHOP), and co-authors used the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) method to evaluate the quality of evidence and develop a list of strong recommendations, conditional recommendations, and ungraded good practice statements. 

For children with clearly diagnosed medical conditions, the medical experts recommend hormonal treatments. If the cause of growth failure is unknown, experts advise against routine growth hormones and recommend a more shared decision-making approach. For children with true primary IGF-I deficiency, the authors recommended treatment with recombinant IGF-I growth factor. 

ISS has been a debated indication, as short stature itself is not a disease but may result from underlying disease. For these children, the authors offer a conditional recommendation of advising against routine growth hormones. Rather, they recommend that parents and providers have a shared decision-making approach discussing the risks and benefits. 

Dr. Grimberg pointed out gaps in knowledge regarding long-term risks of nightly hormone injections given for years, the relationship between adult height and adult quality of life, and diagnosing growth hormone deficiency. The task force recommends that only pediatric endocrinologists manage the evaluation and treatment for GHD, ISS, and primary IGF-I deficiency in children. 

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