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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


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.


ACCME Activity #201861269


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.


  • Read the learning objectives above
  • Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowledge 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.
  • Minimum participation threshold: Take the post-test. A score of 70% or higher is required to pass and proceed to the activity evaluation.
  • Complete the activity evaluation and CME registration. A CE certificate will be emailed to you immediately.

Cultural/Linguistic Competence & Health Disparities

System Requirements

Windows 7 or above
Internet Explorer 8
*Adobe Acrobat Reader
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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