Endocrine
Growth Hormone

Diagnosis: idiopathic short stature
Treatment: Nutropin
The insurer denied Nutropin. The health plan's determination is upheld.

The patient is a male who is seeking growth hormone (GH) treatment under the indication of idiopathic short stature (ISS). His mother's height is 61'' and father's height is 68''. His growth chart shows that he was tracking along 3rd %tile for height since the age of 2 years. Apparently, his growth slowed down and his height and weight dropped below 3%tile. By history, his growth velocity was 2 centimeter (cm) per year at that time but a record of that visit is not available. His evaluation at that time showed normal complete blood count (CBC), normal comprehensive metabolic panel (CMP), normal thyroid function test (TFT) , negative celiac screen, low normal IGF-1 (insulin like growth factor 1), low testosterone (12 ng/dl) and a bone age of 11.75 years.

The Nutropin AQ is not medically necessary for this patient
Guidelines for the use of GH in children with ISS recommend against the routine use of GH in every child with height SDS at or below -2.25 and suggest that decision be made on a case-by-case basis.
This patient's growth velocity has already improved since last year with the onset of puberty, and is expected to improve further with the progression of puberty. His most recent bone age was read as 15 months delayed which should give him adult height prediction within 1 SD of his genetics. Clearly, he does not qualify for GH treatment under the indication of ISS. This patient most likely has combination of familial short stature and constitutional delay in growth and pubertal development. He does not qualify for GH treatment under the ISS indication.