Prevalence of growth hormone (GH) deficiency in previously GH-treated young adults with Prader-Willi syndrome

Objective Some features of subjects with Prader-Willi syndrome (PWS) resemble those seen in growth hormone deficiency (GHD). Children with PWS are treated with growth hormone (GH), which has substantially changed their phenotype. Currently, young adults with PWS must discontinue GH after attainment of adult height when they do not fulfil the criteria of adult GHD. Limited information is available about the prevalence of GHD in adults with PWS. This study aimed to investigate the GH/insulin-like growth factor (IGF-I) axis and the prevalence of GHD in previously GH-treated young adults with PWS. Design Cross-sectional study in 60 young adults with PWS. Measurements Serum IGF-I and IGFBP-3 levels, GH peak during combined growth hormone-releasing hormone (GHRH)-arginine stimulation test. Results Serum IGF-I was <-2 standard deviation scores (SDS) in 2 (3%) patients, and IGFBP-3 was within the normal range in all but one patient. Median (IQR) GH peak was 17.8 mu g/L (12.2; 29.7) [53.4 mU/L] and below 9 mu g/L in 9 (15%) patients. Not one patient fulfilled the criteria for adult GHD (GH peak < 9 mu g/L and IGF-I < -2 SDS), also when BMI-dependent criteria were used. A higher BMI and a higher fat mass percentage were significantly associated with a lower GH peak. There was no significant difference in GH peak between patients with a deletion or a maternal uniparental disomy (mUPD). Conclusions In a large group of previously GH-treated young adults with PWS, approximately 1 in 7 exhibited a GH peak arginine test. However, none of the patients fulfilled the consensus criteria for adult GHD.