Growth hormone treatment during the transition period
- Alan D Rogol, MD, PhD
Alan D Rogol, MD, PhD
- Professor Emeritus
- University of Virginia
The effects of growth hormone deficiency (GHD) differ markedly depending on the life phase. During childhood and puberty, the most important effects of growth hormone (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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- ANTICIPATORY GUIDANCE
- PREDICTING RISK FOR CONTINUING GROWTH HORMONE DEFICIENCY
- Isolated GHD
- Genetic, organic, or structural causes of GHD
- Other predictors
- TESTING FOR CONTINUING GROWTH HORMONE DEFICIENCY
- When should retesting be done?
- Tests to evaluate for continuing GHD
- - IGF-I
- - GH stimulation testing
- Decision to treat in individuals who remain GH deficient as adults
- Dosing and monitoring GH therapy during the transition and into young adulthood
- ADVERSE EFFECTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS