Endocrine Abstracts

Background: Currently we investigate children with possible GH deficiency, but who are healthy, with a normal short stature screen, and without suspicion of other pituitary dysfunction (‘simple short stature’), with full dynamic anterior pituitary function tests (APFT). An abnormal GH peak leads to a second GH stimulation test. We studied the cost implications of only performing a GH stimulation test initially, followed by full APFT if the initial GH peak was low, to ascertain the risk of missing or delaying the diagnosis of significant pituitary pathology.

Methods: Retrospective case notes review of all patients having APFT to investigate ‘simple short stature’ from January 2011 to December 2014. Results were examined to determine the response to GH stimulation, abnormal or suboptimal results of other pituitary hormones and their clinical significance. The costs of performing the different tests were calculated and the potential cost savings over the 4 years determined.

Results: Fifty-five patients had an APFT for ‘simple short stature’ of which 11 had an abnormal GH peak. GH deficiency was confirmed on second testing in four, and in two patients whom only needed a single test for diagnosis. Five patients had other minor biochemical abnormalities, none of which were investigated further as they were deemed clinically insignificant. Testing using the current approach cost £24 255.71 over 4 years, the proposed change would cost £14 289.80 (with full anterior pituitary baseline bloods) or £8575.30 (with IGF1 and GH only), resulting in a cost saving of £9965.91 or £15 680.41 (£181.20 or £285.10/patient).

Discussion: Performing GH stimulation only, at the point where dynamic testing is first indicated to investigate simple short stature, would yield considerable financial savings, a reduction in false positive results and all without missing any other significant pathology. A change of practice is being instigated locally in light of these findings.