Current Diagnostic Tools for Growth Hormone Deficiency Are Inadequate in Children
Diagnosing growth hormone deficiency (commonly abbreviated as GHD) in childhood is difficult. This is mostly because there are no true gold standards for diagnosis; also, the currently available diagnostic tests show relatively poor performance.
The journal Current Opinion in Endocrinology, Diabetes and Obesity in February 2012 published an article called “Diagnosis of growth hormone deficiency in childhood.” It’s a review of recent literature on GHD in children.
This review found that the foundation for diagnosing GHD is a combination of auxology and clinical judgment.
Since provocative growth hormone testing is dependent on variable factors such as body composition and pubertal status, it is poorly reproducible. Additionally, provocative growth hormone testing is limited by the significant variability among the available commercial growth hormone assays.
The review noted that insulin-like growth factor I and insulin-like growth factor-binding protein 3 are not diagnostically useful measurements in isolation. However, when combined with other diagnostic tools, they are useful.
Because pituitary abnormalities can suggest a higher likelihood to having GHD persist into adulthood after a childhood diagnosis, it is useful to use neuroimaging to examine the pituitary gland for these abnormalities.
It may come to pass that genetic testing for GHD diagnosis will be more important in the future; multiple recent reports suggested this possibility, as the review pointed out. Genetic testing is not routinely used now, but these reports’ findings warrant following developments in this area.
Overall, the review found that current diagnostic tools for GHD are suboptimal, save for physicians’ integrated assessment of auxology, bone age, and clinical presentation. The medical community may need to re-assess current diagnostic tools and develop better tools.