GH deficiency in the transitional age: retesting and reassessment of ninety personal cases
Transition is defined as the period of the life of a subject ranging from the conclusion of puberty to full adulthood (2024 y. o.).
The management of patients with GH deficiency in this period of life is related to: assessment deficit etiology: idiopathic or organic; dose of the drug; gain of the full somatic development; maturation of the sexual-reproductive; cardio-metabolic risk assessment; educational aims.
Purpose of the study: In our DH service, since 1999, 1800 children was referred for growth failure. 638 patients was enrolled for GH treatment The average age for the start of therapy was 11.3 years and mean age at discontinuation of therapy was 16.3 years. The mean duration of therapy was 5 years. Currently 250 children with GH are on GH therapy and are monitored with a six months follow-up. All patients have stopped GH treatment after final height attainment (transition phase), we are re-evaluating them for residual GH supply, performing stimulation tests. 90 patients (54 males and 38 females) performed GHRH+arginine re-testing to assess GH secretory capacity after 6± months of discontinuation of therapy.
Materials and methods: Patients undergoing stimulation test with GHRH+arginine: GH was measured at the time 0 30 60 90 and 120 . We also have evaluated basal value of IGF1. Fully auxological and clinical examination evaluation of body composition, was performed at the time of retesting.
Results: The results obtained so far show that many patients with idiopathic GH deficiency recover secretion of the hormone. Rarely, patients with organic (multiple congenital onset pan-hypopituitarism) or acquired deficits (radio-and chemo-treated tumors) recovering residual GH secretion.
Conclusions: Its essential to identify patients whose GH deficiency persists in the transition phase until to adulthood. In these patients the treatment with GH needs to be evaluated balancing benefits vs the overall systemic costs and adverse effect. Complications (survival, quality of life, cardiometabolic outcome), that could result from untreated GH deficit, should be correctly predicted.
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.