ESPE Abstracts

More than 60% of patients with IIGHD have normal GH responses to stimulation when retested at the end of growth, and more than 40 % when retested between one year from the start of treatment and mid puberty. This is probably due to the poor diagnostic accuracy of GH stimulation tests and IGF-I measurement. These are strong arguments in favour of early retesting to avoid the burden, cost and potential side effects of unnecessary treatment. There should be no risk of early termination of GH therapy since the available data indicate that patients who stop treatment after retesting do not to end up shorter than those who continue treatment. We suggest to perform retesting after one year in patients with a non satisfactory response to treatment and at mid puberty in the remaining. Priming with sex steroids at retesting may be used in prepubertal patients in pubertal age (>11 for boys and >10 for girls). We suggest to use the same GH stimulation test used at diagnosis with a peak cut-off of 7 μg/L. In selected cases when the diagnosis is particularly uncertain retesting could be performed after 3-6 months before starting treatment. Patients and family should be aware from the beginning that the diagnosis is uncertain and that retesting will be performed at some point and treatment could be eventually stopped. This would minimize the risk of losing physician credibility and would encourage patients’ and families’ empowerment. We suggest long-term follow- up for all patients who stop treatment after retesting. Improvement of the diagnostic phase with revision of current guidelines is needed.