Consensus and controversies about diagnosing GH deficiency: a Delphi survey by the GH research society
Arlien-Søborg, M C Radovick, S Boguszewski, M C S Bidlingmaier, M Johannsson, G Grimberg, A Ho, K K Y Biller, B M K Choong, C S Hoffman, A R
Arlien-Søborg, M C
Radovick, S
Boguszewski, M C S
Bidlingmaier, M
Johannsson, G
Grimberg, A
Ho, K K Y
Biller, B M K
Choong, C S
Hoffman, A R
Affiliation
Aarhus University Hospital; Rutgers University; Federal University of Parana; LMU University Hospital; LMU Munich; Sahlgrenska University Hospital; University of Gothenburg; Children's Hospital of Philadelphia; University of Pennsylvania; Garvan Institute of Medical Research; St. Vincent's Hospital; Massachusetts General Hospital; Harvard Medical School; Perth Children's Hospital; University of Western Australia; Stanford University; Cincinnati Children's Hospital Medical Center; Federal University of Parana; University of Oslo; Conception University Hospital; Université Paris-Saclay; Assistance Publique – Hopitaux de Paris; University Hospital of Basel; University of Rome "Tor Vergata"; I.R.C.C.S. "Bambino Gesù" Children's Hospital; University of Manchester; University of Southern California; Children's National Hospital; Oregon Health Sciences University; University Hospital Schleswig-Holstein; Vita-Salute San Raffaele University; IRCCS San Raffaele Hospital; Christie Hospital NHS Foundation Trust; University of Manchester; National Center for Child Health and Development Tokyo; Karolinska Institute; University of Copenhagen; University of California; Tongji Hospital; Huazhong University; Nemours Children's Health Jacksonville; Cedars-Sinai Medical Center; Erasmus University Medical Centre; University of Birmingham; Birmingham Health Partners; University Hospitals Birmingham NHS Foundation Trust; Oregon Health Science University; University of Sheffield; Karolinska University Hospital; Universidade do Estado do Rio de Janeiro; Charité Universitätsmedizin; Wilhelmina Children's Hospital; University Medical Center; St. Joseph's Hospital and Medical Center; University of Arizona
Other Contributors
Publication date
2025-05-07
Subject
Collections
Research Projects
Organizational Units
Journal Issue
Abstract
Purpose: Biochemical tests are required for diagnosing GH-deficiency in children and adults, but controversies remain regarding diagnostic criteria and type of biochemical tests. The aim of the study is to map the clinical practices of GHD diagnosis in children and adults.
Methods: The Growth Hormone Research Society members initiated a Delphi survey of the diagnosis of GHD in children and adults. Pediatric (n = 18) and adult (n = 25) endocrinologists from 14 countries participated and rated their extent of agreement with 61 statements using a Likert-type-scale (1-7). Consensus was predefined as ≥ 80% of panelists rating their agreement unidirectionally as either ≥ 5 (agreement) or ≤ 3 (disagreement).
Results: The pediatric panel reached consensus on 17 of 29 (59%) statements on diagnosis in children, whereas the adult panel reached consensus on 28 of 32 (88%) statements on adult patients. There was general agreement to test for GHD in an appropriate clinical context and also on the timing of testing for GHD in both children and adults. A subnormal IGF-I level was considered diagnostic in both children and adults with panhypopituitarism. In children, there was consensus to recommend the arginine stimulation test and the glucagon test. The insulin tolerance test (ITT) was considered gold standard in adults and there was also consensus to recommend the macimorelin test. A stimulated GH cut-off < 5μg/l was consistent with severe GHD in children, whereas test-specific cut-offs were recommended in adults.
Conclusion: Consensus on the GHD diagnosis was lower in pediatric practice, mainly with respect to choice and interpretation of GH stimulation tests.
Citation
Arlien-Søborg MC, Radovick S, Boguszewski MCS, Bidlingmaier M, Johannsson G, Grimberg A, Ho KKY, Biller BMK, Choong CS, Hoffman AR, Backeljauw P, Boguszewski CL, Bollerslev J, Brue T, Chanson P, Christ E, Cianfarani S, Clayton PE, Cohen P, Dauber A, Fleseriu M, Gebauer J, Giustina A, Higham CE, Horikawa R, Höybye C, Juul A, Lodish M, Luo X, Mauras N, Miller KK, Melmed S, Neggers SJCMM, Karavitaki N, Rosenfeld R, Ross R, Savendahl L, Schilbach K, Collett-Solberg PF, Strasburger CJ, Tritos NA, van Santen HM, Yuen KCJ, Jorgensen JOL. Consensus and controversies about diagnosing GH deficiency: a Delphi survey by the GH research society. Pituitary. 2025 May 7;28(3):57. doi: 10.1007/s11102-025-01526-z.
Type
Article