Arlien-Søborg M C, Radovick S, Boguszewski M C S, Bidlingmaier M, Johannsson G, Grimberg A, Ho K K Y, Biller B M K, Choong C S, Hoffman A R, Backeljauw P, Boguszewski C L, Bollerslev J, Brue T, Chanson P, Christ E, Cianfarani S, Clayton P E, Cohen P, Dauber A, Fleseriu M, Gebauer J, Giustina A, Higham C E, Horikawa R, Höybye C, Juul A, Lodish M, Luo X, Mauras N, Miller K K, Melmed S, Neggers S J C M M, Karavitaki N, Rosenfeld R, Ross R, Savendahl L, Schilbach K, Collett-Solberg P F, Strasburger C J, Tritos N A, van Santen H M, Yuen K C J, Jorgensen J O L
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Pediatrics, Rutgers University-Robert Wood Johnson Medical School New, Brunswick, NJ, USA.
Pituitary. 2025 May 7;28(3):57. doi: 10.1007/s11102-025-01526-z.
Biochemical tests are required for diagnosing GH-deficiency in children and adults, but controversies remain regarding diagnostic criteria and type of biochemical tests. The aim of the study is to map the clinical practices of GHD diagnosis in children and adults.
The Growth Hormone Research Society members initiated a Delphi survey of the diagnosis of GHD in children and adults. Pediatric (n = 18) and adult (n = 25) endocrinologists from 14 countries participated and rated their extent of agreement with 61 statements using a Likert-type-scale (1-7). Consensus was predefined as ≥ 80% of panelists rating their agreement unidirectionally as either ≥ 5 (agreement) or ≤ 3 (disagreement).
The pediatric panel reached consensus on 17 of 29 (59%) statements on diagnosis in children, whereas the adult panel reached consensus on 28 of 32 (88%) statements on adult patients. There was general agreement to test for GHD in an appropriate clinical context and also on the timing of testing for GHD in both children and adults. A subnormal IGF-I level was considered diagnostic in both children and adults with panhypopituitarism. In children, there was consensus to recommend the arginine stimulation test and the glucagon test. The insulin tolerance test (ITT) was considered gold standard in adults and there was also consensus to recommend the macimorelin test. A stimulated GH cut-off < 5μg/l was consistent with severe GHD in children, whereas test-specific cut-offs were recommended in adults.
Consensus on the GHD diagnosis was lower in pediatric practice, mainly with respect to choice and interpretation of GH stimulation tests.
生化检测对于诊断儿童和成人的生长激素缺乏症是必需的，但在诊断标准和生化检测类型方面仍存在争议。本研究的目的是梳理儿童和成人生长激素缺乏症（GHD）诊断的临床实践。
生长激素研究学会成员发起了一项关于儿童和成人生长激素缺乏症诊断的德尔菲调查。来自14个国家的18名儿科内分泌学家和25名成人内分泌学家参与其中，使用李克特量表（1 - 7）对他们与61条陈述的一致程度进行评分。共识被预先定义为≥80%的小组成员将他们的同意单向评为≥5（同意）或≤3（不同意）。
儿科小组在29条关于儿童诊断的陈述中有17条（59%）达成了共识，而成人小组在32条关于成人患者的陈述中有28条（88%）达成了共识。在适当的临床背景下检测生长激素缺乏症以及儿童和成人生长激素缺乏症检测的时间方面存在普遍共识。在全垂体功能减退的儿童和成人中，胰岛素样生长因子 - I（IGF - I）水平低于正常被认为具有诊断意义。在儿童中，对于推荐精氨酸刺激试验和胰高血糖素试验达成了共识。胰岛素耐量试验（ITT）在成人中被视为金标准，并且对于推荐麦角新碱试验也达成了共识。儿童中刺激后生长激素水平<5μg/l与严重生长激素缺乏症一致，而在成人中推荐特定试验的临界值。
儿科实践中关于生长激素缺乏症诊断的共识较低，主要在生长激素刺激试验的选择和解读方面。
