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In spite of the ongoing debates ...

In spite of the ongoing debates, we as clinicians require practical working solutions. A general consensus is in place that the low IGF-1 value appears diagnostic of GHD [<100ng/ml]; however, the caveat is that the normal IGF-1 level does not exclude the diagnosis of GHD. As clinicians in the real world, we treat the patient not the lab test. There is a subgroup of physicians and third party payors who insist upon growth hormone stimulation tests such as insulin tolerance test (Clonodine or L-Dopa stimulation test) with peak growth hormone <9ng/mI as the gold standard. Most of us agree with a consensus standard that an IGF-1 level below 100ng/ml is a clear indication for replacement.

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