Expert: Claes-Gustaf Nordquist, M.D. - 8/27/2008

Question
Hi,

I need some assistance.  I am appealing a decision of my insurance carrier for HGH treatment.  I am a sixty year old white female and have several conditions that warrant the use of HGH and my physicians have labeled the treatment as medically necessary.

The insurance company denied my claim based on a stance of the American Association of Clinical Endocrinolgists which the insurance company quotes as saying HGH therapy is contraindicated in meningioma.  I, in my research, have found no such stance.

My question to you is whether you have any credible evidence either way.  I have been on HGH therapy since early 2005 based on short bowel syndrome, a diagnosis of osteopenia and other malabosorption syndrome issues.  

The meningioma is a 1.1 x.6 extra-axial calcified mass in the right temporal region which was diagnosed in late 2005.  As I stated, HGH was started in the beginning of 2005. I had also swelling in the 7th & 8th cranial that was presumptively another tumor.

I was asked to stop taking HGH in October 2007 and was put on Semorelin based on a study indicating children on HGH had a small percentage of recurrent tumors.  

Prior to ceasing the HGH, my DEXA scan revealed significant bone growth, the tumor remained stagnant, the swelling in the 7th & 8th cranial went away and my fatigue and overall well being improved significantly.

With a little over two month off the HGH, my IGF-1 went to 51 from a 94, which was 5 points lower than when I was diagnosed with dHGH. The insurance wanted me to do a provoking study at this point.  The neuro-oncologist I see and PCP both agreed that because I have seizures (with burning smells and other warning signs) that a provoking test is too dangerous for me.  Both also agree that the HGH is medically necessary.

Please let me know what you think as soon as you can.  Further, I appreciate your effort.

Thanks.


Answer
Since you were on HGH for quite some time without problems and with good results I fail to see what the problem is - except that your insurance company wants to save money! But I'm a Swede living in Sweden so I have NO knowledge of US insurance policies in this situation. So I do not think I can be of much help unfortunately!