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Three societies present treatment guidelines for idiopathic short stature
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A panel of 32 experts from the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology Workshop recently published a summary of advances in the diagnosis and treatment of idiopathic short stature.
The panel reviewed literature and discussion summaries and reached a consensus on each section of the document.
A height below –2 standard deviation (SD) score without findings of disease evident after a full evaluation by a pediatric endocrinologist that included stimulated growth hormone levels served as the auxologic definition of ISS.
Children with ISS do not require MRI. Although psychosocial problems have been associated with ISS, true psychopathology is rare.
GH therapy at doses as high as 53 g/kg per day for children shorter than 2.25 SD score is approved in the United States and seven other countries. Lower cutoffs are proposed in other countries.
Evidence suggests that aromatase inhibitors served as a prognostic factor for adult height in men with ISS. However, no data on adult height were available for analysis. Moreover, due to frequent inaccuracy, adult height should not be an absolute criterion for clinical decision making regarding GH therapy. GH therapy should be considered more strongly in shorter children. Children with ISS who undergo GH therapy experience a mean increase in height of 3.5 cm to 7.5 cm. The average duration required to achieve this result is 4 to 7 years. However, variability was observed in these responses. The investigators observed a similar safety profile for children with ISS as with other indications for this therapy. Barometers of success of GH therapy in the first year of treatment include increases in height SD score of 0.3 to 0.5. A useful method for assessing compliance and GH sensitivity is insulin-like growth factor I levels. Consistent elevation — defined as –2.5 SD score — may prompt dose reduction of GH to be considered. Psychological counseling may replace or be used as an adjunct to hormone therapy.
For more information, visit:
http://jcem.endojournals.org/content/93/11/4210.full.pdf.