Growth Hormone Deficiency
Pharmacy/Prescription Drugs

The patient is a female who is seeking growth hormone (GH) treatment under the indication of idiopathic short stature (ISS). She was born after 33 weeks of gestation and her birth weight was 3 lbs 11 oz. Her mother's height is 63 inches and father's height is 65 inches (mid parental height of 61.5+/-2''). Her mother was late in her puberty and reached menarche at age 16 years. Family history is significant for short stature on the father side of the family and her paternal grandmother is 4' 10'' tall and paternal uncle is 5' 2''. By history, she has always been small and growing at lower percentiles for height. Nutropin AQ is being requested and is under review.

The health plan's determination is upheld. Nutropin AQ is not medically necessary. With the progression of puberty, this patient's growth has improved and she has grown 5.6 cm in 7.83 months which gives her a growth velocity of 8.6 cm per year, which is pubertal confirming the impression of familial short stature with constitutional delay. ISS is a heterogeneous condition and not all children with ISS will respond equally to GH treatment. The Pediatric Endocrine Society Guidelines for Growth Hormone and Insulin-Like Growth Factor-1 Treatment in Children and Adolescents recommend GH treatment for ISS on a case-by-case basis after assessment of physical and psychological burdens, and discussion of risks and benefits. As this patient's height has never been 2.25 SD below the mean for age, she does not qualify for GH treatment under the indication of ISS. Therefore, Nutropin AQ is not medically necessary.