Care of patients with childhood onset growth hormone deficiency before and after the transition period
C. Courtillot, R. Baudoin, T. Du Souich, J. Golmard, L. Saatdjian & P. Touraine
Objectives: To investigate how CO-GHD patients are taken care of in paediatrics, during the transition period and in long-term adult follow-up.
Methods: Retrospective cohort study of CO-GHD patients, transferred in our adult department between 1994 and 2011. Paediatric charts were available for all patients. For adult follow-up, parameters of metabolic, bone and cardiovascular status were recorded at several hospitalisations: the first one (V0) and at 1 (V1), 3 (V3) and 5 (V5) years after transition. Three groups of patients were studied: treated (G1) and untreated (G2) persistent GHD, and resolutive GHD (G3).
Results: We present a cohort of 113 patients with median age at transition of 19.5 years.
Aetiologies of GHD were acquired in 54%, congenital in 34% and idiopathic in 12% of cases. GHD was complete in 72% of patients. Other pituitary deficits were often associated in congenital (70%) or acquired GHD (78%), idiopathic GHD were generally isolated (64%). In childhood, GH was started at a mean dose of 34.6 μg/kg/day. Mean difference between final and target heights was −0.4S.D..
At transition, 14% of patients had a normal GH axis. 48 patients completed V1, among whom 30 were under GH (mean dose 0.62 mg/day). At V3 and V5, 32 and 22 patients were studied respectively (18 and 5 under GH). Preliminary data show that, over time, mean IGF1 drops in G1, in parallel with GH doses, but always remains higher than in G2, in which it is stable. Mean BMI shows overweight in both G1 and G2: it remains stable in G1, but tends to rise in G2. Surprisingly, mean spine BMD tends to increase in G2 and drop in G1.
Conclusion: This is the largest cohort of CO-GHD patients followed until adulthood. It allows us to evaluate our medical practices, in times when adult GH supplementation remains controversial.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.