Background: The GST is commonly used in children and adolescents for the diagnosis of growth hormone (GH) deficiency. Evidence supports the use of sex steroid priming to improve diagnostic accuracy in GH provocation tests. This project, undertaken on behalf of the BSPED Clinical Committee, aims to identify current practice and develop consensus in sex hormone priming and GST protocols for the development of standardised UK protocols.
Method: (1) Audit of sex hormone priming and GST protocols among UK tertiary paediatric endocrine centres. (2) DELPHI consensus process over 8 weeks, involving all UK paediatric endocrine specialists undertaking the GST. An electronic survey, developed by a working group of 4 consultant paediatric endocrinologists and approved by the BSPED clinical committee, was distributed via the BSPED newsletter. The survey consisted of 9 statements with 4 fixed responses and free text comments covering aspects of the criteria and preparation used for sex hormone priming; the glucagon dose, hypoglycaemia risk and presence of medical personnel for the GST. Consensus was considered achieved when 70% of respondents agreed with the statements.
Results: Audit: Priming was used in 20/22 centres with variations in patient criteria (bone/chronological age or pubertal stage), drug preparation and dose. GST was performed in 20/22 centres under 13 protocols with differences in glucagon doses (0.150.1 mcg/kg, maximum 0.51 mcg), timing of samples and length of tests (150240 min), Delphi: 39 responses from 17 tertiary and 12 secondary centres (26 tertiary paediatric endocrinologists,12 paediatricians with endocrine interest, 1 paediatric endocrine nurse). All statements reached consensus. Four statements for priming agreed (86100%) informing a new guideline. Five statements for GST concerning glucagon dose and safety criteria agreed (89100%) but with a range of comments. Common themes from free texts included the definition of hypoglycaemia (2.63.5 mmol/l), when a test can proceed or should be abandoned, and the immediate availability and skills needed for a doctor on the unit supporting the nurse performing the test.
Conclusions: Consensus was reached for the use of sex steroid priming for GH testing and safety precautions required for the GST. This information will inform the development of safe standardised BSPED national protocols.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes