Management options for pediatric growth hormone deficiency

Abstract

ABSTRACTIntroduction: Growth hormone deficiency (GHD), in 1:4000 children, is congenital or acquired inability to produce serum GH from the pituitary. Management of pediatric GHD is evolving and requires review.Areas covered: Controversies about GHD continue regarding diagnostic criteria, referral criteria, testing, optimal treatment, safety, monitoring, and management during transition to adulthood. Efforts are ongoing to improve efficacy of GH therapy, including prolonging growth by delaying puberty, and once weekly preparations. Early diagnosis of GHD permits starting GH at a young age, normalizing height while keeping mid-normal IGF-I levels. After completion of linear growth, young adults with childhood-onset GHD are unlikely to re-start GH therapy unless the re-start is supervised by the pediatric endocrinologist, or unless the adult provider has experience with pituitary endocrinology.Expert opinion: GH replacement therapy for GHD has benefits for growth (in childhood) and for body composition, hematologic/cardiovascular/metabolic status, and quality of life in childhood leading into adulthood. Improved therapy combinations may lead to enhanced efficacy and better match with normal physiology. Diagnosis of GHD and early GH therapy for childhood cancer survivors with GHD is appropriate when supervised by a team of oncologists and endocrinologists. New approaches to improving outcomes require ongoing monitoring/surveillance.