Gerhard Binder1, Thomas Reinehr2, Lourdes Ibáñez3,4, Susanne Thiele5, Agnès Linglart6, Joachim Woelfle7, Paul Saenger8, Markus Bettendorf9, Agnieszka Zachurzok10, Bettina Gohlke7, Tabitha Randell11, Berthold P Hauffa12, Hedi L Claahsen van der Grinten13, Paul-Martin Holterhus14, Anders Juul15, Roland Pfäffle16, Stefano Cianfarani17,18. 1. Pediatric Endocrinology, University Children's Hospital, Tübingen, Germany, gerhard.binder@med.uni-tuebingen.de. 2. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Datteln, Germany. 3. Endocrinology Department, Institut de Recerca Pediàtrica Sant Joan de Déu, University of Barcelona, Barcelona, Spain. 4. CIBERDEM, Instituto de Salud Carlos III, Madrid, Spain. 5. Division of Experimental Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Lübeck, Lübeck, Germany. 6. AP-HP, Endocrinology and Diabetes for Children, Bicêtre Paris Sud Hospital, Paris, France. 7. Department of Paediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany. 8. NYU Winthrop University Hospital, Mineola, New York, USA. 9. Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany. 10. Department of Pediatrics and Pediatric Endocrinology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. 11. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 12. Department of Pediatric Endocrinology, University of Duisburg-Essen, Essen, Germany. 13. Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands. 14. Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Christian-Albrechts-University Kiel and University Hospital Schleswig-Holstein, Kiel, Germany. 15. Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 16. Department of Paediatric Endocrinology, Children's Hospital, Leipzig, Germany. 17. Dipartimento Pediatrico Universitario Ospedaliero, "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy. 18. Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden.
Abstract
INTRODUCTION: Almost 20 years after the first international guidelines on the diagnosis and treatment of GHD have been published, clinical practice varies significantly. The low accuracy of endocrine tests for GHD and the burden caused by ineffective treatment of individual patients were strong motives for national endocrine societies to set up national guidelines regarding how to diagnose GHD in childhood. This audit aims to review the current state and identify common changes, which may improve the diagnostic procedure. METHODS: A group of eight German pediatric endocrinologists contacted eight pediatric endocrinologists from Spain, France, Poland, the UK, the Netherlands, Denmark, Italy, and the US. Each colleague responded as a representative for the own country to a detailed questionnaire containing 22 open questions about national rules, guidelines, and practice with respect to GHD diagnostics and GH prescription. The results were presented and discussed in a workshop and then documented in this study which was reviewed by all participants. RESULTS: National guidelines are available in 7 of 9 countries. GH is prescribed by pediatric endocrinologists in most countries. Some countries have established boards that review and monitor prescriptions. Preferred GH stimulation tests and chosen cutoffs vary substantially. Overall, a trend to lowering the GH cutoff was identified. Priming is becoming more popular and now recommended in 5 out of 9 countries; however, with different protocols. The definition of pretest-conditions that qualify the patient to undergo GH testing varies substantially in content and strictness. The most frequently used clinical sign is low height velocity, but definition varies. Height, IGF-1, and bone age are additional parameters recommended in some countries. CONCLUSIONS: GHD diagnostics varies substantially in eight European countries and in the US. It seems appropriate to undertake further efforts to harmonize endocrine diagnostics in Europe and the US based on available scientific evidence.
INTRODUCTION: Almost 20 years after the first international guidelines on the diagnosis and treatment of GHD have been published, clinical practice varies significantly. The low accuracy of endocrine tests for GHD and the burden caused by ineffective treatment of individual patients were strong motives for national endocrine societies to set up national guidelines regarding how to diagnose GHD in childhood. This audit aims to review the current state and identify common changes, which may improve the diagnostic procedure. METHODS: A group of eight German pediatric endocrinologists contacted eight pediatric endocrinologists from Spain, France, Poland, the UK, the Netherlands, Denmark, Italy, and the US. Each colleague responded as a representative for the own country to a detailed questionnaire containing 22 open questions about national rules, guidelines, and practice with respect to GHD diagnostics and GH prescription. The results were presented and discussed in a workshop and then documented in this study which was reviewed by all participants. RESULTS: National guidelines are available in 7 of 9 countries. GH is prescribed by pediatric endocrinologists in most countries. Some countries have established boards that review and monitor prescriptions. Preferred GH stimulation tests and chosen cutoffs vary substantially. Overall, a trend to lowering the GH cutoff was identified. Priming is becoming more popular and now recommended in 5 out of 9 countries; however, with different protocols. The definition of pretest-conditions that qualify the patient to undergo GH testing varies substantially in content and strictness. The most frequently used clinical sign is low height velocity, but definition varies. Height, IGF-1, and bone age are additional parameters recommended in some countries. CONCLUSIONS: GHD diagnostics varies substantially in eight European countries and in the US. It seems appropriate to undertake further efforts to harmonize endocrine diagnostics in Europe and the US based on available scientific evidence.
Authors: Florencia Clément; Romina P Grinspon; Daniel Yankelevich; Sabrina Martín Benítez; María Carolina De La Ossa Salgado; María Gabriela Ropelato; María Gabriela Ballerini; Ana C Keselman; Débora Braslavsky; Patricia Pennisi; Ignacio Bergadá; Gabriela P Finkielstain; Rodolfo A Rey Journal: Front Endocrinol (Lausanne) Date: 2021-02-03 Impact factor: 5.555