Is priming with sex steroids useful for defining patients who will benefit from GH treatment?

Classic criteria for diagnosing GHD include: short stature (height below the third percentile), slow growth velocity, delayed bone age and failure to produce growth hormone in response to two provocative tests. While provocation tests can diagnose complete GHD, debate still exists about of what constitutes a normal or a subnormal GH response in subjects with "idiopathic" short stature or constitutional delay of growth and puberty. It has been suggested that in children with intermediate GH responses to pharmacologic stimuli, a pre-treatment with sex steroids priming may be of value in enhancing the GH response and in helping to clarify the diagnosis, particularly in children with delayed onset of puberty. Nevertheless, the use of priming with sex steroids prior to GH stimulation test in the peripubertal period is still controversial because it is considered an "unphysiologic method" and may mask children with transient GHD. Further studies and uniform guidelines are needed before solving this intriguing puzzle.