Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2008) 17 P16

BSPED2008 Poster Presentations (1) (56 abstracts)

Treatment of children with GH: an audit of adherence to NICE guidelines

R El Khairi , M Urs & V Nanduri


Watford General Hospital, Watford, UK.


Background: The National Institute of Clinical Excellence (NICE) published guidelines in May 2002 on the use of GH in children, recommending GH in 4 conditions: GH deficiency (GHD), Turner Syndrome, Prader-Willi Syndrome and chronic renal insufficiency.

Aim: To audit whether GH prescribing at our hospital adheres to NICE guidelines.

Methods: A retrospective audit was performed of children commenced on GH treatment between May 2002 and July 2008 in a district general hospital.

Results: Thirty patients (14 M:16 F) on GH were identified. Indications included GHD (15 patients) and TS (six patients). Nine patients were prescribed GH outside NICE guidelines (1 SGA, 5 skeletal dysplasias, 1 Noonan syndrome, 1 Kabuki syndrome, 1 short stature).

In 100% of patients treatment was initiated and monitored by a paediatrician with a special expertise in endocrinology. A shared care agreement with the GP to provide treatment was in place for 29 of 30 (97%) patients.

About 8 of 15 (53%) children had isolated GHD and seven had multiple pituitary hormone deficiency (MPHD) and/or defined CNS pathology. In 100% of patients with GHD, the diagnosis was supported by auxological measurements and bone age. About 100% of children with GHD had 1 pituitary stimulation test, IGF-1 and IGFBP-3. About 14 of 15 (93%) patients had a peak GH <20 mU/l. About 9 of 15 (60%) patients with GHD had an MRI brain. About 100% of patients with MPHD and CNS pathology had an MRI.

Treatment response was re-evaluated within 1 year in 30 of 30 patients. Good compliance was noted in all patients. Four patients reported minor side-effects. Of 15 patients with GHD, 12 (80%) showed an increase in growth velocity (HV) of >50%. GH was discontinued in 1 patient at 15.93 years at final height 174.5 cm (Ht SDS=0.22). Age at diagnosis of TS ranged from birth to 11.13yrs. About 3 of 4 patients had an increase in HV >50%.

Conclusion and recommendations: About 9 of 30 patients were prescribed GH for conditions outside NICE guidelines. Guidelines were adhered to with respect to monitoring and shared care. Areas to be addressed: 1) Two stimulation tests to diagnose isolated GHD; 2) MRI for all children with GHD; 3) Use of GH in other conditions needs to be discussed.

Volume 17

36th meeting of the British Society for Paediatric Endocrinology and Diabetes

British Society for Paediatric Endocrinology and Diabetes 

Browse other volumes

Article tools

My recent searches

No recent searches.