The Australasian Paediatric Endocrine Group (APEG) has reminded clinicians not to rely on random measures of circadian hormones, in one of its top five recommendations on low value practices.
APEG said random measurement of hormones such as growth hormone and testosterone were ‘of limited diagnostic utility’ given that levels may peak and plateau throughout the day.
“By and large most endocrinologists recognise that measuring random levels of hormones is a waste of time but it still happens,” spokesperson Professor Fergus Cameron said.
Professor Cameron, immediate past president of APEG, said new evidence warranted other recommendations developed as part of the RACP’s EVOLVE program and the Choosing Wisely campaign.
“The process is to create awareness and try to normalise practice,” he said.
The Group recommended against relying solely on bone-age assessment in infants and toddlers less than two years of age.
“Bone ageing measurements are inherently so inaccurate at that age as to be meaningless, whereas later in life we use it a lot and it has a lot of utility.”
“People are doing those investigations because they think that’s what you do for short stature at any age; so they’re not really thinking it is meaningless.”
The issue was complicated as bone age was required on applications for PBS authority to prescribe growth hormone.
APEG also recommended against routine measurement of insulin-like growth factor binding protein 3 (IGFBP-3) due to its low sensitivity for the workup and diagnosis of children with short stature.
The Group also advised against the use of GnRH agonists to increase final adult height in females with early puberty given evidence they were associated with a risk of polycystic ovary syndrome (PCOS) and compromised bone health.
Their use outside clinical trials was not recommended.
Professor Cameron said the use of aromatase inhibitors for short stature was also on the ‘fringes of therapy’.
“Theoretically there was biological logic to delay fusion of epiphyseal growth plates, prolong the window of growth and increase final height. It seemed useful to exploit this, particularly in males.”
“But there are always unforeseen issues, for example, a change in morphology of the vertebra or sperm production in developing testes. The evidence that they improve height by themselves was negligible and there were serious concerns about safety. On balance, they shouldn’t be used unless in the context of a clinical trial.”