NICE has recommended that recombinant human growth hormone should be used only for adults with severe growth hormone deficiency that is severely affecting their quality of life. To be apart of this group, NICE says a person should:
- have a peak growth hormone response of less than 9 mU/litre in the ‘insulin tolerance test’ for growth hormone deficiency or a similar low result in another reliable test, and
- have an impaired quality of life because of their growth hormone deficiency (judged using a specific questionnaire called the 'Quality of life assessment of growth hormone deficiency in adults’ designed to assess the quality of life in people with growth hormone deficiency; a person should score at least 11 in this questionnaire), and
- already be receiving replacement hormone treatment for any other deficiencies of pituitary hormones if he or she has one or more other deficiencies.
NICE has also said that people who have recombinant human growth hormone should have their quality of life checked again 9 months after starting the treatment. This is so that treatment can be stopped if it isn’t having a positive effect, which is judged to be the case if the person’s score on the quality of life questionnaire hasn’t improved by at least 7 points.
NICE has made the following recommendation for the treatment of people who develop growth hormone deficiency in early adulthood (before 25 years of age), after their growth has slowed down (that is they grow less than 2 cm in a year). The level of growth hormone should be checked. If the peak growth hormone response is less than 9 mU/litre in the insulin tolerance test for growth hormone deficiency or there is a similar low result in another reliable test, then growth hormone treatment should be given until what is known as ‘adult peak bone mass’ is achieved (this happens at around age 25 years). After adult peak bone mass has been achieved an assessment of whether it is appropriate to continue with the human growth hormone treatment should be made, in line with the three measures described above.
Finally, NICE has recommended that the first stages of growth hormone treatment (starting treatment, adjusting the dose to suit the person, and assessing how well it is working) should be carried out by a consultant endocrinologist who has a special interest in growth hormone disorders (a consultant endocrinologist is a doctor who has specialised in disorders involving hormones). If, after the first stages, the growth hormone is to be prescribed by the person’s GP, then the GP and consultant should ‘share’ the person’s care.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.