Somatropin for Growth Hormone Deficiency

Key Message

We identified 2 evidence-based guidelines that provide recommendations for the clinical management of children and adults with growth hormone deficiency. The American Association of Clinical Endocrinologists and American College of Endocrinology guideline provides recommendations on assessment, screening, diagnostic testing, treatment, and monitoring for a range of patients with different causes of adult growth hormone deficiency. The recommendations emphasize accurate diagnosis using appropriate growth hormone cut points for different growth hormone–stimulation tests and careful interpretation of serum growth hormone and insulin-like growth factor-1 levels. Treatment with recombinant human growth hormone should be carried out with consideration of the benefits and risks specific to each individual patient. The Pediatric Endocrine Society guideline provides recommendations for the clinical management of children and adolescents with growth failure due to growth hormone deficiency. The guideline lists various conditions for which growth hormone deficiency can be diagnosed by conventional approaches without growth hormone–stimulation testing. The treatment dose of growth hormone should be calculated based on weight and body surface area and not on insulin-like growth factor-1 levels. The guideline highlights that the initial growth hormone dose, subsequent dosing, and discontinuation of pediatric doses should be assessed based on each individual patient. Both guidelines recognize the uncertainty of long-term safety (i.e., posttreatment effects) of growth hormone treatment, which is a limitation of both guidelines.