Criteria for diagnosis of growth hormone deficiency: does it exist?

ABSTRACT

Exploration of the criteria for diagnosing hormone deficiency used by physicians practicing in SaudiArabia. A questionnaire addressing the issue of criteria for diagnosing growth hormone deficiency was distributed to 104 physicians practicing in Saudi Arabia who were attending a course in endocrinology. Analysis of the data received from 48 physicians was carried out. Only one criteria from 10 clinical and biochemical criteria was chosen by 2 [4%], 2 by 9 [19%], 3 by 8 [17%], 4 by 15 [31%], 5 by 9 [19%], 6 by 2 [4%] and 7 by 3 [6%] physicians. The majority, 31 [65%] chose subnormal growth velocity as an important criteria. Twenty-four [50%] chose the subnormal physiological growth hormone values taken during sleep or after vigorous exercise, 26 [54%] chose the 2 provocative pharmacological tests, and 18 [37.5%] and 9 [19%] chose one and 3 pharmacological tests. Subnormal random single growth hormone measurement was chosen by 8 [17%] physicians. Low somatomedin C [IgFl] and subnormal IgFl binding proteins were the choice of 18 [37.5%] and 4 [8%]. Favorable biochemical response to growth hormone was the choice of 16 [33%]. When the choices were combined only 3 [6%] physicians took the most likely correct combination choice ie subnormal growth velocity, delayed bone age coupled with subnormal growth hormone values taken during sleep or exercise, and 2 provocative pharmacological tests. Definite diagnostic criteria for growth hormone deficiency is lacking in this country. A nationwide criteria, and subsequent central control of growth hormone is required