Endocrine Abstracts

Background: Biochemical diagnosis of Growth Hormone Deficiency (GHD) in UK adults(>18yrs) follows NICE criteria (2003) with diagnostic GH on dynamic stimulation test (DST) of <3ng/mL. Local guidance requires 2xDSTs with peak GH <3ng/ml (ITT first-line, GST/AST 2nd-line) for diagnosis in those age>24yrs, and <7ng/ml in 17-25yrs. Recently published criteria¹ highlight updated BMI and age-based cut-offs for the aforementioned DSTs.

Objectives: To assess compliance to NICE criteria and local guidance and determine impact of age/BMI-based cut-offs on GHD diagnosis.

Methodology: Retrospective audit of 50 patients (n = 46 included, 24F, mean age 32yrs (17-71yrs)), identified from GH dataset (2005-2024), using local electronic patient record for demographics, clinical data, treatment history, DST results (registered with local audit committee 4358). Inclusion criteria: age>17yrs and undergoing DSTs for GHD diagnosis. Pseudoanonymised data was collected (Microsoft Excel).

Results: Data for 46/50 (n = 9TYA, n = 37adults) were available for analysis. 41/46 had history of tumour/cancer and radiotherapy (Tumour diagnosis: brain astrocytoma/glioma/medulloblastoma 24/41, pituitary 6/41, nasopharyngeal 4/41, leukaemia 2/41, other 5/41). 29/46 were on GH replacement, 28/29 met NICE criteria (n = 14 >18 yrs, n = 15 18-24yrs). First DST: ITT(19/46), GST(20/46), AST(7/46). Mean BMI 27 kg/m2(range17-37). Application of age/BMI-based cut-offs didn’t change diagnosis in TYA group. 37 patients were >25yrs; 23/37 having 2xDST. Mean(SD) BMI 28.8(5) kg/m2. DST results showed differences between diagnosis using the NICE vs Yuen 2023 criteria (Table), with 26 patients meeting NICE criteria vs 18 meeting Yuen cut-offs.

Conclusion: A high compliance is shown to the NICE criteria. Weight and age-based cut-offs have a significant impact on GH diagnosis in those>25yrs when GST is used as first-line diagnostic test.

Reference 1. Yuen KCJ et al, Endocr Connect2023;12(7):1–19