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CME: The current and emerging landscape of pediatric growth hormone deficiency (GHD) pharmacotherapy

Activity Description / Statement of Need:

Growth hormone deficiency (GHD) is characterized by inadequate secretion of growth hormone by the pituitary gland. The condition may arise from a variety of causes, including tumors, radiation, medications, traumatic brain injury, or genetic defects. In children, GHD is characterized by pronounced short stature, defined as 2 or more standard deviations from the mean based on age and sex. Because short stature may be caused by a variety of other factors, including genetics, hypothyroidism, and Turner syndrome, estimating the prevalence of GYHD in the pediatric population is challenging. Studies suggest that GHD may occur in 1 out of every 4,000 to 10,000 children. There is no gold standard for diagnosis of GHD in children. Clinical practice guidelines from the Pediatric Endocrine Society currently caution against the use of growth hormone provocation testing in the diagnosis of GHD given the unreliability of results. Auxology, biochemical evaluation, imaging, and physical examination remain the cornerstones of GHD diagnosis in children. Clinicians should be aware of appropriate strategies of diagnosis of GHD in pediatric patients, as improper diagnosis may delay effective treatment and increase risk for secondary complications.

Target Audience:

The following healthcare professionals: Endocrinologists, pediatricians, and primary care physicians; physician assistants, nurse practitioners, and pharmacists who practice in endocrinology; and any other healthcare professionals with an interest in or who clinically encounter patients with GHD.


This program is supported by an educational grant from Sandoz.

Learners may participate in this activity free of charge.


Release Date: November 19, 2020 -- Expiration Date: November 19, 2022

Faculty: Dennis Styne, MD

Agenda

Introduction, faculty disclosures

A brief primer: Epidemiologic, pathophysiologic, etiologic features, clinical signs and symptoms

  • Common ground: Human growth hormone biochemical pathway
  • Etiology: Causes of pediatric GHD and differential diagnoes
  • Candidates for testing
  • Guideline-recommended testing strategies (auxology, biochemistry, imaging, physical examination)
    • Biochemstry: IGF-1 and IGFBP-3
    • Imaging: Cranial MRI, bone radiographs
    • Role of sex hormone priming in diagnosis
  • Growth hormone provocative testing: Relative reliability
  • Consequences and complications of pediatric GHD and implications for early diagnosis
  • Patient case(s)

Treatment options available for pediatric GHD

  • Society guidelines
  • Goals of therapy
  • Pharmacotherapy: Growth hormone therapy

·      - Investigational agents: Long-acting (e.g., somapacitan) and needle-less options

  • Transitioning care to adulthood
  • Best practices
  • Clinical controversies
  • Monitoring parameters, counseling points, barriers to care, and patient education
  • Patient case(s)

Summary, conclusions, and best practice recap

Learning Objectives

By the end of the session the participant will be able to:

  • Evaluate evidence-based recommendations for the diagnosis of pediatric GHD.
  • Identify barriers to care in the treatment and diagnosis of pediatric GHD.
  • Develop a plan for treatment of a pediatric patient with GHD and describe best practices for transitioning care from adolescence to adulthood.

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through ScientiaCME. ScientiaCME is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: ScientiaCME designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ toward the AMA Physician's Recognition Award. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME-MOC_badge

ABIM MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABP MOC Recognition Statement: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Pediatrics's (ABP) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit.

PhysiciansFor maintenance of certification (MOC) credit, you must enter your board certification ID # and birth date correctly.  It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive MOC credit for this activity. Please note: Not all activities on this site provide MOC credit. If this activity does not specify that it provides MOC credit in this section, then it does NOT provide MOC credit.

Pharmacists

ScientiaCME is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmaceutical education. This program is approved for 1.0 hours (0.1 CEUs) of continuing education.  Proof of participation will be posted to your NABP CPE profile within 4 to 6 weeks to participants who have successfully completed the post-test. Participants must participate in the entire presentation and complete the course evaluation to receive continuing pharmacy education credit. ACPE # 0574-0000-20-052-H01-P. CPE credit effective 11/19/20 and expires 11/19/22. This is a Application (A) type activity.

PharmacistsYou must enter your NABP # and birth date correctly so that proof of participation can be posted to your NABP CPE profile. It is the learner's responsibility to provide this information completely and accurately at the completion of the activity. Without providing it, the learner will NOT receive CPE credit for this activity.

Nurse Practitioners (NPs): The American Academy of Nurse Practitioners accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.  ScientiaCME will provide NPs who successfully complete each activity with a certificate of participation indicating that the activity was designated for AMA PRA Category 1 Credit(s)™.

Physician Assistants: The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)™ from organizations accredited by the ACCME.


Faculty Disclosure and Resolution of COI

As a provider of continuing medical education, it is the policy of ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is the policy of ScientiaCME to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review ScientiaCME.

Faculty Disclosure: Dennis M. Styne, MD, Yocha Dehe Chair of Pediatric Endocrinology, 
University of California, is a stockholder in Bristol Myers Squibb and Teva.

Disclosures of Educational Planners: Charles Turck, PharmD, BCPS, BCCCP, CEO of ScientiaCME, has no relevant conflicts of interest to disclose.

Disclosures of Peer Reviewers:
Michael Gottschalk, MD, PhD has no relevant financial disclosures.
Colin P. Hawkes, MD, PhD has no relevant financial disclosures.

Commercial Support Disclosure: This program is supported by an educational grant from Sandoz.

Instructions

  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.
  • View the online activity. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.
  • Take the post-test
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural and Linguistic Competence

System Requirements

PC
Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
MAC
Mac OS 10.2.8
Safari or Chrome or Firefox
*Adobe Acrobat Reader
Internet Explorer is not supported on the Macintosh

*Required to view Printable PDF Version


Perform Pre-Test (optional)

Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.


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