Current prescribing practices and opinions about growth hormone therapy: results of a nationwide survey of paediatric endocrinologists.

BACKGROUND: With the advent of several new treatment indications for recombinant hGH, endocrinologists are being asked to make some difficult decisions regarding eligibility for treatment. The purpose of this study was to summarize prevailing attitudes about GH diagnosis and treatment among paediatric endocrinologists.

METHODS: We sent surveys to all active US members of the Lawson Wilkins Pediatric Endocrine Society (LWPES) listed in the 2004-05 directory (excluding our own group of physicians). Thirty-eight per cent of the surveys were returned and 182 met eligibility for analysis. Surveys were divided into four parts: demographic data, answers reflecting current diagnosis practices for GH deficiency and treatment with GH, attitudes and clinical practice for the idiopathic short stature (ISS) diagnosis, and four case studies. Through a series of questions, we elicited the influence towards prescribing GH of current height, growth velocity, predicted height, pubertal progression and other variables. Results were entered into a Microsoft Access database and statistical evaluation was conducted.

RESULTS: Eighty-eight per cent of respondents answered 'no' to the statement that there is good consensus on who should be treated with GH and over 90% answered 'no' to the statement that secretagogue testing was the best way to determine if a child would benefit from GH. Factors listed by respondents as important for prescribing GH include: growth velocity less than the 25th percentile, target height less than the 5th percentile and pubertal stage greater than Tanner 2. Current height was also important; however, answers varied as to what height percentile indicated the need for treatment. When queried about prescribing practices for nonstraightforward cases, 62% of respondents answered that the cost of GH influenced their decision to treat, 55% responded that concerns of future unknown side-effects affected their decision and 37% noted family persistence influenced their decision. In response to queries about ISS, 82% answered that they were currently using the new indication and 69% answered that there was a need for the indication. The statement that short stature could be a disability received a 'yes' response from 78%. Answers to the four cases reflected lack of consensus, with one-third of all respondents answering that they would treat each case, one-third choosing to treat more than two of the cases and one-third treating less than two of the cases.

CONCLUSION: Endocrinologists differed in their answers about cause for treatment with GH but in general favoured use of poor growth velocity, poor target height and low IGF-1 levels as indications to treat a paediatric patient with GH.