Growth Hormone Deficiency (GHD) and Other Indications for Growth Hormone Therapy –
Adult and Transition from Childhood

Prohibited Substance: Growth Hormone

This Checklist is to guide the athlete and their physician on the requirements for a TUE application that will allow the TUE Committee to assess whether the relevant ISTUE Criteria are met.

Please note that the completed TUE application form alone is not sufficient; supporting documents MUST be provided. A completed application and checklist DO NOT guarantee the granting of a TUE. Conversely, in some situations a legitimate application may not include every element on the checklist.

Application form included
               All sections completed in legible handwriting   
   All information submitted in [language]   
   A signature from the applying physician    
   The Athlete’s signature   
Medical report included should include details of:
Medical history:
Aetiology: Genetic growth hormone deficiency, intracranial disease, pituitary tumor; irradiation, surgery, or bleeding in the hypothalamic-pituitary area; traumatic brain injury or whole body irradiation. Treatment of other pituitary hormone deficiencies. Furthermore, in case of:
a) Adult : Fatigue, poor exercise capacity, abdominal obesity, impaired psychosocial function.
b) Transition : Evidence of short stature and growth deceleration based on standard deviation; any specific treatment as a child. Physician’s interpretation of diagnosistic tests performed during transition.
Physical exam:
a) Adults: May be unremarkable
b) Transition: Height, weight, body mass index
Diagnostic test results should include copies of:
Laboratory tests: Insulin-like growth factor-1 (in ng/mL) measured after 2–4 weeks off recombinant human growth hormone in those on therapy; no earlier than 12 months after brain injury in those with post-traumatic etiology.
Other hormone levels: thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin. Morning cortisol as a reliable indicator of adrenocorticotropic hormone (ACTH).
MRI of pituitary/hypothalamus to assess structural abnormalities for all new onset GHD (any age)
If diagnosed during childhood, gene (GH-1 or GHRH-R) or transcription factor mutations (e.g., PROP-1, POU1F1 (Pit-1)) known to result in hypopituitarism
Growth hormone stimulation tests may include:
a) Adults: Insulin tolerance test, glucagon stimulation test, growth hormone–releasing hormone (GHRH)-arginine stimulation test, macimorelin test. Results of stimulation testing during transition (if performed).
b) Transition: Insulin tolerance test, glucagon stimulation test, macimorelin test.
Note: Stimulation tests are not required when hypopituitarism is diagnosed (≥3 other pituitary hormone deficits or gene or transcription factor mutations present (see above). Additional tests are also not required if IGF-1 levels 2–4 weeks after stopping treatment remain below -2 SD.