Background:

Growth hormone deficiency (GHD) in children is one of many causes for short stature. GHD in childhood may or may not persist into adulthood depending on the cause. Growth hormone  stimulation tests are important tools for diagnosis and re-evaluation of GHD in children. However, execution and interpretation of growth hormone function tests can vary widely. The NVE aims to harmonize function tests within the Netherlands to obtain more unambiguous results. In this abstract we describe the development of several GH stimulation tests for children.

Methods:

Several NVE workgroups were formed to develop national protocols for the arginine stimulation test, GHRH-arginine stimulation test and the combined arginine-clonidine stimulation test for children. For each protocol, guidelines, literature and currently used protocols in different hospitals (n=19) were collected and discussed. Based on these documents and clinical experience, up-to-date and harmonized protocols were drafted. After critical review by experts in the field, the harmonized protocols are published on the NVE website.

Results and conclusion:

An important update regarding GH stimulation tests is the effect of body mass index (BMI) on GH peak values. GH peak values are lower in people with higher BMI. Also, the nearly-finished guideline “Diagnostiek en behandeling groeihormoondeficiëntie bij kinderen” has been incorporated in the new protocols for GH-stimulation tests.

Two protocols were recently developed and are currently under revision: Protocols for the arginine stimulation test for diagnosis of GHD in children and the GHRH-arginine stimulation test for re-evaluation of GHD in adolescents who have reached (near) adult height. It is expected that these protocols will become available at the NVE website in Q1 2023. A protocol for the combined arginine-clonidine stimulation test will soon be drafted as well and should be available on the NVE website in Q2 2023. Moreover, the currently existing protocol for the clonidine stimulation test will be revised to include above-mentioned updates.