Current Practice in Diagnosis and Treatment of Growth Hormone Deficiency in Childhood: A Survey from Turkey
Şükran Poyrazoğlu1, Teoman Akçay2, İlknur Arslanoğlu3, Mehmet Emre Atabek4, Zeynep Atay5, Merih Berberoğlu6, Abdullah Bereket5, Aysun Bideci7, İffet Bircan8, Ece Böber9, Şule Can10, Yaşar Cesur11, Şükran Darcan12, Korcan Demir13, Bumin Dündar10, Betül Ersoy14, İhsan Esen15, Ayla Güven1, Cengiz Kara16, Mehmet Keskin17, Selim Kurtoğlu18, Nihal Memioğlu19, Mehmet Nuri Özbek20, Tolga Özgen11, Erkan Sarı21, Zeynep Şıklar6, Enver Şimşek22, Serap Turan5, Ediz Yeşilkaya21, Bilgin Yüksel23, Feyza Darendeliler11İstanbul University, İstanbul Faculty Of Medicine, Department Of Pediatric Endocrinology, İstanbul, Turkey2Bakırköy Dr. Sadi Konuk Research And Training Hospital, Clinic Of Pediatric Endocrinology, İstanbul, Turkey
3Düzce University Faculty Of Medicine, Department Of Pediatric Endocrinology, Düzce, Turkey
4Necmettin Erbakan University Faculty Of Medicine, Department Of Pediatric Endocrinology, Konya, Turkey
5Marmara University Faculty Of Medicine, Department Of Pediatric Endocrinology, İstanbul, Turkey
6Ankara University Faculty Of Medicine, Department Of Pediatric Endocrinology, Ankara, Turkey
7Gazi University Faculty Of Medicine, Department Of Pediatric Endocrinology, Ankara, Turkey
8Akdeniz University Faculty Of Medicine, Department Of Pediatric Endocrinology, Antalya, Turkey
9Dokuz Eylül University Faculty Of Medicine, Department Of Pediatric Endocrinology, İzmir, Turkey
10Tepecik Educational And Research Hospital, Clinic Of Pediatric Endocrinology, İzmir, Turkey
11Bezmialem Vakıf University Faculty Of Medicine, Department Of Pediatric Endocrinology, İstanbul, Turkey
12Ege University Faculty Of Medicine, Department Of Pediatric Endocrinology, İzmir, Turkey
13Dr. Behçet Uz Children Disease And Surgery Training And Research Hospital, Clinic Of Pediatric Endocrinology, İzmir, Turkey
14Celal Bayar University Faculty Of Medicine, Department Of Pediatric Endocrinology, Manisa, Turkey
15Fırat University Faculty Of Medicine, Department Of Pediatric Endocrinology, Elazığ, Turkey
16Ondokuz Mayıs University Faculty Of Medicine, Department Of Pediatric Endocrinology, Samsun, Turkey
17Gaziantep University Faculty Of Medicine, Department Of Pediatric Endocrinology, Gaziantep, Turkey
18Erciyes University Faculty Of Medicine, Department Of Pediatric Endocrinology, Kayseri, Turkey
19American Hospital, Clinic Of Pediatric Endocrinology, İstanbul, Turkey
20Diyarbakır Children’S State Hospital And Diyarbakır Training And Research Hospital, Diyarbakır, Turkey
21Gülhane Military Medical Academy, Department Of Pediatric Endocrinology, Ankara, Turkey
22Osman Gazi University Faculty Of Medicine, Department Of Pediatric Endocrinology, Eskişehir, Turkey
23Çukurova University Faculty Of Medicine, Department Of Pediatric Endocrinology, Adana, Turkey
Objective: Approaches to diagnosis and treatment of growth hormone deficiency (GHD) in children vary among countries and even among centers in the same country. This survey, aiming to facilitate the process of preparing the new consensus on GHD by the Turkish Pediatric Endocrinology and Diabetes Society, was designed to evaluate the current practices in diagnosis and treatment of GHD in different centers in Turkey.
Methods: A questionnaire covering relevant items for diagnosis and treatment of GHD was sent out to all pediatric endocrinology centers.
Results: Twenty-four centers returned the questionnaire. The most frequently used GH stimulation test was L-dopa, followed by clonidine. Eighteen centers used a GH cut-off value of 10 ng/mL for the diagnosis of GHD; this value was 7 ng/mL in 4 centers and 5 ng/mL in 2 centers. The most frequently used assay was immunochemiluminescence for determination of GH, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 concentrations. Sex steroid priming in both sexes was used by 19 centers. The most frequently used starting dose of recombinant human GH (rhGH) in prepubertal children was 0.025-0.030 mg/kg/day and 0.030-0.035 mg/kg/day in pubertal children. Growth velocity was used in the evaluation for growth response to rhGH therapy in all centers. Anthropometric measurements of patients every 3-6 months, fasting blood glucose, bone age and thyroid panel evaluation were used by all centers at follow-up. Main indications for cessation of therapy were decreased height velocity and advanced bone age. Fourteen centers used combined treatment (rhGH and gonadotropin-releasing analogues) to increase final height.
Conclusion: Although conformity was found among centers in Turkey in current practice, it is very important to update guideline statements and to modify, if needed, the approach to GHD over time in accordance with new evidence-based clinical studies.
Manuscript Language: English
