Diagnosis: Growth hormone deficiency GHD

Treatment: Medication- Nutropin

The insurer denied coverage of Nutropin. The denial was upheld.

This is a female child diagnosed with growth hormone deficiency (GHD). This request is for Nutropin. She has central precocious puberty (CPP) and she is on Lupron. She started growth hormone (GH) therapy. Her GH stimulation test with clonidine and L-dopa peaked at 6.8 and 9.3 respectively. Her height velocity was reported to be 5.4 cm/year. In late 2018 she was at Tanner 3-4 and breast tissue slightly less stimulated than last visit. Earlier that year her insulin like growth factor 1 (IGF1) was 331, her insulin like growth factor binding protein 3 (IGF-BP3) was 4614 and growth hormone (GH) was 3.5.

This patient met biochemical criteria. GH stimulation testing peaked at less than 10ng/ml. The patient had a normal IGF1.

The patient did not meet auxological criteria as pretreatment height and height velocity are normal.

The Pediatric Endocrine Society recommends against making a diagnosis of growth hormone deficiency based solely on failed growth hormone stimulation testing.

The patient does not have a pre-treatment height less than or equal to -2.25 SD. The patient therefore does not meet idiopathic short stature criteria.