Transition Care of Patients With Growth Hormone Deficiency from Pediatric Endocrinologists to Adult Endocrinologists

Abstract

To review whether growth hormone (GH) therapy should be continued into young adulthood, beyond achievement of final height, when GH deficiency persists, to summarize the recent evidence of the benefits of GH treatment during the transition period, and to address currently debated issues involving diagnosis, treatment, and transition of care. Primary literature was reviewed in the following areas: the benefits and risks of GH therapy during the transition period, the diagnostic criteria for GH deficiency and recommended testing procedures during transition, the optimal dose of GH therapy during transition, and the factors to consider in the transition of care from the pediatric to the adult endocrinologist. Studies support the continuation of GH therapy through the transition period until accrual of peak bone mass, rather than cessation of GH treatment when adult height has been achieved. Continued GH treatment in patients with persistent GH deficiency after achieving final height has been associated with significant additional bone maturation and improved overall metabolic profile. The selection of the most appropriate methods and cutoff values for retesting GH deficiency during the transition period remains a challenge. Reassessment of the optimal GH dose is a key component of transition care. For patients with GH deficiency that will likely persist into adulthood, it is important to begin discussing possible continuation of GH treatment early in the management of GH deficiency. Clear communication between pediatric and adult endocrinologists will be needed to determine the timing of the patient-care transition and to minimize the interruption of GH therapy during the transition period.