ESPE Yearbook of Paediatric Endocrinology

Clin Endocrinol (Oxf). 2021 Mar;94(3):392–398. doi: 10.1111/cen.14364. PMID: 33140844.

In this retrospective study, random growth hormone (GH) levels were compared between newborns (mean age 9.07±6.6 days) with or without GH deficiency. A cut off of 4.5 ng/ml was established as the GH value to diagnose congenital GH deficiency. This value had a 100% sensitivity and 85% specificity for diagnosing congenital GH deficiency.

Growth hormone (GH) is the key hormone that regulates linear growth. However, GH has other important metabolic effects such as regulating glucose, carbohydrate and fat metabolism. In the newborn congenital GH deficiency may present with hypoglycemia, jaundice and micropenis. GH levels tend to be elevated in the newborn period indicating a state of GH resistance. Establishing a diagnosis of GH deficiency in the newborn period can be challenging as provocation testing cannot be done in this age group. So, the idea of measuring a random GH level in the newborn period as an indicator of GH deficiency is appealing.

The current findings support the value of random GH measurement in newborns. However, a previous study (1) indicated a GH cut off level of 7ng/ml and another study (2) indicated a cut off level of <5 ng/ml as indicative of GH deficiency in the newborn period. So, the optimal level of a random GH to diagnose congenital GH deficiency has yet to be established. It is important to note that GH levels will vary with the specific assay method and that these assays have varying performance characteristics so this should be kept in mind when using specific cut off values.

Reference: 1. Collett-Solberg PF, Ambler G, Backeljauw PF, Bidlingmaier M, Biller BMK, Boguszewski MCS, Cheung PT, Choong CSY, Cohen LE, Cohen P, Dauber A, Deal CL, Gong C, Hasegawa Y, Hoffman AR, Hofman PL, Horikawa R, Jorge AAL, Juul A, Kamenický P, Khadilkar V, Kopchick JJ, Kriström B, Lopes MLA, Luo X, Miller BS, Misra M, Netchine I, Radovick S, Ranke MB, Rogol AD, Rosenfeld RG, Saenger P, Wit JM, Woelfle J. Diagnosis, genetics, and therapy of short stature in children: a growth hormone research society international perspective. Hormone Res Paediatr. 2019;92(1):1–14.2. Grimberg A, DiVall SA, Polychronakos C, Allen DB, Cohen LE, Quintos JB, Rossi WC, Feudtner C, Murad MH; Drug and Therapeutics Committee and Ethics Committee of the Pediatric Endocrine Society. Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr. 2016;86(6):361–397.