There are a range of screening and diagnostic tests for the investigation of short stature, some of which are unpleasant and even dangerous for the patient. Growth hormone (GH) heterogeneity and wide assay biases cause additional complications for interpretation of results. We have used questionnaires to assess protocols and practice in the investigation of short stature by paediatricians and clinical biochemists in Wales.
Responses from laboratory staff and paediatricians were obtained from all 13 centres in Wales where such investigations are undertaken. Five Paediatricians and 8 laboratories had written investigative protocols but only 2 paediatricians and 8 laboratories felt they gave a defined interpretation. A range of screening tests for GH deficiency including IGF-1, random GH and exercise tests are in use. Clonidine stimulation is the test of choice in the majority of centres to assess the GH axis, but 8 different protocols are described. GH is measured in 4 Welsh laboratories using 2 automated immunoassay methods. However 9 different cut-off values for defining abnormal GH responses are quoted and in 3 centres biochemists and paediatricians quoted different cut-offs.
This review of practice demonstrates the need for regional guidelines which encompass the clinical evaluation and biochemical assessment of the GH-IGF-1 axis and include defined interpretation of tests. Furthermore, there is need for improved communication between laboratory and clinical staff.
08 - 11 Apr 2002
British Endocrine Societies