Growth hormone deficiency: Strategies and indications to continue growth hormone therapy in transition from adolescence to adult life

The most common practice in children with growth hormone (GH) deficiency is to discontinue GH treatment in adolescence after attainment of final height. Childhood-onset GH deficiency (GHD) that continues into adulthood and is not treated may be associated with more severe consequences than GHD acquired as an adult. This raises the question of the importance of GH for continuing tissue maturation after longitudinal growth has stopped. Data from recent studies suggest that muscle and bone maturation is arrested when GH treatment is discontinued at final height in adolescents in whom severe GHD continues into adulthood. These patients also develop, even in the short term, well-known cardiovascular risk factors associated with GHD in adults. Retesting for GHD is crucial in adolescence because a considerable number of patients will not have severe GHD according to the criteria set for adults. Continuing replacement therapy in these patients is warranted, but cost-benefit comparisons of treatment are still under debate and a lack of acceptance, and hence reimbursement, for such treatment is still common. In this review, the management and organization of transition, with and without continuing GH replacement therapy, are also discussed. Copyright (C) 2003 S. Karger AG, Basel.