GHD Diagnostics in Europe and the US: An Audit of National Guidelines and Practice: Hormone Research in Paediatrics

G. Binder, T. Reinehr, L. Ibáñez, S. Thiele, A. Linglart, J. Woelfle, P. Saenger, M. Bettendorf, A. Zachurzok, B. Gohlke, T. Randell, B.P. Hauffa, H.L. Claahsen Van Der Grinten, P.-M. Holterhus, A. Juul, R. Pfäffle, S. Cianfarani

Research output: Contribution to journalArticlepeer-review


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. © 2019 S. Karger AG, Basel. Copyright: All rights reserved.
Original languageEnglish
Pages (from-to)150-156
Number of pages7
JournalHorm. Res. Paediatr.
Issue number3
Publication statusPublished - 2020


  • Cutoff
  • Growth hormone deficiency
  • Growth hormone stimulation test
  • Guidelines
  • Priming
  • arginine
  • clonidine
  • glucagon
  • human growth hormone
  • insulin
  • somatomedin C receptor
  • testosterone enantate
  • sex hormone
  • algorithm
  • Article
  • body mass
  • childhood
  • clinical audit
  • clinical practice
  • comparative study
  • Europe
  • France
  • Germany
  • growth hormone deficiency
  • health care personnel
  • hormonal regulation
  • hormone substitution
  • human
  • Italy
  • neurologic disease
  • neurosecretion
  • neurosecretory dysfunction
  • onset age
  • Poland
  • practice guideline
  • prescription
  • primary health care
  • priority journal
  • puberty
  • questionnaire
  • reimbursement
  • blood
  • Denmark
  • endocrine system examination
  • female
  • infant
  • international cooperation
  • male
  • Netherlands
  • reference value
  • Spain
  • United Kingdom
  • United States
  • Diagnostic Techniques, Endocrine
  • Female
  • Gonadal Steroid Hormones
  • Human Growth Hormone
  • Humans
  • Infant
  • International Cooperation
  • Male
  • Practice Guidelines as Topic
  • Reference Values
  • Surveys and Questionnaires


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