Management of patients with childhood onset GH deficiency (COGHD) in the transition phase
María Ángeles Bazarra Castro1, Caroline Sievers1, Susanne Bechtold-Dalla Pozza2, Hans Peter Schwarz2 & Günter Karl Stalla1
Introduction: Discontinuation of GH therapy in patients with COGHD after attainment of final height has been associated with impaired somatic development, altered peak bone mass and cardiovascular risk factors. A well-managed transition of care between paediatric and adult health services can improve the clinical and social outcomes in adolescents with GHD.
Objective: To assess the quality of the transfer between children and adult medical services in our clinic and to confirm the previous diagnosis.
Patients: One hundred and twenty-two transition patients (68 males and 54 females; age at first visit: <25 years) with pituitary deficiency (ICD-10: E.23) referred to us and treated at our clinic between 2000 and 2009.
Results: Among the 122 transition patients, 75 presented with GHD (45 males, 30 females), of which 20 suffered from an idiopathic GHD (iGHD) and 55 from an organic GHD (oGHD). Most transferred males with iGHD discontinued endocrinologic control and GH substitution completely (five patients) or after the first contact (three patients). Most females with GHD presented regularly after transferral for medical check-ups independent of diagnosis (22 patients). In case that the previous test was borderline or performed more than 1 year ago and in order to confirm the diagnosis, we retested 34 out of the 75 patients with GHD (45.3%). The preferred test was GHRH-arginine (20 patients, 58.9%). Other test used was IHT alone (nine patients) or together with GHRH-arginine (four patients). Out of 20 patients with iGHD 11 (55%) were retested, of which seven were still GH deficient (63.6%). All 23 oGHD retested patients (out of 55) were deficient.
Conclusion: Efforts should be made to improve the transferral of male adolescents with GHD, particularly with iGHD, since they seem to escape medical care. An individualised healthcare transition programme, created with paediatric in collaboration with adult endocrinologists may help to contribute towards successful transition.