Global Experts Reveal Major Gaps in Growth Hormone Deficiency Diagnosis

Growth hormone deficiency (GHD) diagnosis remains surprisingly controversial among global experts, according to a landmark international survey that exposes significant gaps in clinical consensus. The Growth Hormone Research Society conducted a comprehensive Delphi survey involving 43 leading endocrinologists from 14 countries to map current diagnostic practices.

The results reveal a striking disparity between pediatric and adult practice. While adult specialists achieved consensus on 88% of diagnostic statements, pediatric experts agreed on only 59% of key issues. This disagreement primarily centers on which stimulation tests to use and how to interpret results in children.

Despite controversies, some important agreements emerged. Both pediatric and adult panels agreed that GHD testing should occur within appropriate clinical contexts and established clear timing guidelines. For children with panhypopituitarism, a subnormal IGF-I level was considered diagnostic. The arginine stimulation test and glucagon test gained consensus support for pediatric use, while the insulin tolerance test remains the adult gold standard, with the macimorelin test also endorsed.

Critical diagnostic thresholds were established: stimulated growth hormone levels below 5μg/L indicate severe GHD in children, while adults require test-specific cutoffs. These findings have immediate clinical implications, as inconsistent diagnostic approaches can lead to missed diagnoses or inappropriate treatment.

The study underscores an urgent need for standardized diagnostic protocols, particularly in pediatric endocrinology where the lack of consensus may compromise patient care and research comparability across institutions.