Transition of Growth Hormone Treatment: Adolescence to Adulthood

Kristina   I.   Todorova-Koteva; Manmohan   K.   Kamboj

Abstract

For patients with childhood-onset growth hormone deficiency, the transition from adolescence to adulthood is a critical phase. A number of studies support the concept that during this transition phase, the adolescent with confirmed severe persistent GHD should continue growth hormone treatment. Major issues that need to be addressed during this phase include the need for confirmation of the diagnosis of GHD and approporiate dosage of the recombinant human growth hormone (rhGH). Confirmation of GHD through provocative testing of growth hormone secretion is usually required unless there is a proven genetic or structural lesion which persists from childhood and causes the deficiency. Insulin induced hypoglycemia and growth hormone releasing hormone (GHRH) plus arginine are the growth hormone stimulation tests of choice with use of appropriate cut-off limits of growth hormone levels. Individual titration of the rhGH dose is recommended and measurement of insulin like growth factor one (IGF-1) levels need to be followed for monitoring the adequacy of replacement. The mean growth hormone replacement dose for the adolescent in transition, however, is still higher than in adulthood. Growth hormone offers beneficial effects on body composition, bone mineral density, cardiac function, lipid profile, quality of life, and is most likely to benefit those patients who have more severe GHD.

Keywords: Growth hormone (GH), growth hormone deficiency (GHD), recombinant human growth hormone (rhGH), insulin like growth factor one (IGF-1)

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