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Growth hormone treatment during the transition period

Author
Alan D Rogol, MD, PhD
Section Editor
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

The effects of growth hormone deficiency (GHD) differ markedly depending on the life phase. During childhood and puberty, the most important effects of GH are on linear growth, and high doses of GH are required for replacement therapy. During adulthood, GHD is associated with altered body composition and diminished quality of life, and much lower GH doses are needed to counteract these effects. The diagnosis and management of these phases of GHD are discussed in separate topic reviews. (See "Diagnosis of growth hormone deficiency in children" and "Treatment of growth hormone deficiency in children" and "Growth hormone deficiency in adults".)

Only a minority of children with GHD will remain deficient as adults and require ongoing GH therapy. The "transition period" between these phases is loosely defined as occurring from mid-to-late teens until six to seven years after reaching near-adult height. The transition period raises the following clinical questions, which will be addressed in this topic review:

Which individuals with childhood GHD will remain deficient as adults?

When and how should testing be performed to determine whether an individual has persistent GHD?

How should patients be monitored during and after the transition period to determine appropriate dosing for GH therapy?

             

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Literature review current through: Nov 2016. | This topic last updated: Mon Jul 11 00:00:00 GMT 2016.
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References
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  1. Clayton PE, Cuneo RC, Juul A, et al. Consensus statement on the management of the GH-treated adolescent in the transition to adult care. Eur J Endocrinol 2005; 152:165.
  2. Sode-Carlsen R, Farholt S, Rabben KF, et al. Growth hormone treatment for two years is safe and effective in adults with Prader-Willi syndrome. Growth Horm IGF Res 2011; 21:185.
  3. Tauber M, Moulin P, Pienkowski C, et al. Growth hormone (GH) retesting and auxological data in 131 GH-deficient patients after completion of treatment. J Clin Endocrinol Metab 1997; 82:352.
  4. Molitch ME, Clemmons DR, Malozowski S, et al. Evaluation and treatment of adult growth hormone deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96:1587.
  5. Adan L, Trivin C, Sainte-Rose C, et al. GH deficiency caused by cranial irradiation during childhood: factors and markers in young adults. J Clin Endocrinol Metab 2001; 86:5245.
  6. Hartman ML, Crowe BJ, Biller BM, et al. Which patients do not require a GH stimulation test for the diagnosis of adult GH deficiency? J Clin Endocrinol Metab 2002; 87:477.
  7. Ho KK, 2007 GH Deficiency Consensus Workshop Participants. Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol 2007; 157:695.
  8. Secco A, di Iorgi N, Napoli F, et al. Reassessment of the growth hormone status in young adults with childhood-onset growth hormone deficiency: reappraisal of insulin tolerance testing. J Clin Endocrinol Metab 2009; 94:4195.
  9. Loche S, Bizzarri C, Maghnie M, et al. Results of early reevaluation of growth hormone secretion in short children with apparent growth hormone deficiency. J Pediatr 2002; 140:445.
  10. Toogood AA, Beardwell CG, Shalet SM. The severity of growth hormone deficiency in adults with pituitary disease is related to the degree of hypopituitarism. Clin Endocrinol (Oxf) 1994; 41:511.
  11. Biller BM, Samuels MH, Zagar A, et al. Sensitivity and specificity of six tests for the diagnosis of adult GH deficiency. J Clin Endocrinol Metab 2002; 87:2067.
  12. Maghnie M, Aimaretti G, Bellone S, et al. Diagnosis of GH deficiency in the transition period: accuracy of insulin tolerance test and insulin-like growth factor-I measurement. Eur J Endocrinol 2005; 152:589.
  13. Corneli G, Di Somma C, Prodam F, et al. Cut-off limits of the GH response to GHRH plus arginine test and IGF-I levels for the diagnosis of GH deficiency in late adolescents and young adults. Eur J Endocrinol 2007; 157:701.
  14. Yuen KC, Biller BM, Molitch ME, Cook DM. Clinical review: Is lack of recombinant growth hormone (GH)-releasing hormone in the United States a setback or time to consider glucagon testing for adult GH deficiency? J Clin Endocrinol Metab 2009; 94:2702.
  15. Wilson JR, Utz AL, Devin JK. Effects of gender, body weight, and blood glucose dynamics on the growth hormone response to the glucagon stimulation test in patients with pituitary disease. Growth Horm IGF Res 2016; 26:24.
  16. Dichtel LE, Yuen KC, Bredella MA, et al. Overweight/Obese adults with pituitary disorders require lower peak growth hormone cutoff values on glucagon stimulation testing to avoid overdiagnosis of growth hormone deficiency. J Clin Endocrinol Metab 2014; 99:4712.
  17. Berg C, Meinel T, Lahner H, et al. Diagnostic utility of the glucagon stimulation test in comparison to the insulin tolerance test in patients following pituitary surgery. Eur J Endocrinol 2010; 162:477.
  18. Corneli G, Di Somma C, Baldelli R, et al. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index. Eur J Endocrinol 2005; 153:257.
  19. Attanasio AF, Shavrikova E, Blum WF, et al. Continued growth hormone (GH) treatment after final height is necessary to complete somatic development in childhood-onset GH-deficient patients. J Clin Endocrinol Metab 2004; 89:4857.
  20. Maiter D, Abs R, Johannsson G, et al. Baseline characteristics and response to GH replacement of hypopituitary patients previously irradiated for pituitary adenoma or craniopharyngioma: data from the Pfizer International Metabolic Database. Eur J Endocrinol 2006; 155:253.
  21. Koltowska-Häggström M, Mattsson AF, Shalet SM. Assessment of quality of life in adult patients with GH deficiency: KIMS contribution to clinical practice and pharmacoeconomic evaluations. Eur J Endocrinol 2009; 161 Suppl 1:S51.
  22. Carroll PV, Drake WM, Maher KT, et al. Comparison of continuation or cessation of growth hormone (GH) therapy on body composition and metabolic status in adolescents with severe GH deficiency at completion of linear growth. J Clin Endocrinol Metab 2004; 89:3890.
  23. Kołtowska-Häggström M, Geffner ME, Jönsson P, et al. Discontinuation of growth hormone (GH) treatment during the transition phase is an important factor determining the phenotype of young adults with nonidiopathic childhood-onset GH deficiency. J Clin Endocrinol Metab 2010; 95:2646.
  24. Rosilio M, Blum WF, Edwards DJ, et al. Long-term improvement of quality of life during growth hormone (GH) replacement therapy in adults with GH deficiency, as measured by questions on life satisfaction-hypopituitarism (QLS-H). J Clin Endocrinol Metab 2004; 89:1684.
  25. McKenna SP, Doward LC, Alonso J, et al. The QoL-AGHDA: an instrument for the assessment of quality of life in adults with growth hormone deficiency. Qual Life Res 1999; 8:373.
  26. Svensson J, Bengtsson BA. Safety aspects of GH replacement. Eur J Endocrinol 2009; 161 Suppl 1:S65.
  27. Losa M, Scavini M, Gatti E, et al. Long-term effects of growth hormone replacement therapy on thyroid function in adults with growth hormone deficiency. Thyroid 2008; 18:1249.
  28. Giavoli C, Libé R, Corbetta S, et al. Effect of recombinant human growth hormone (GH) replacement on the hypothalamic-pituitary-adrenal axis in adult GH-deficient patients. J Clin Endocrinol Metab 2004; 89:5397.