ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2009) 19 P106

The challenges of implementing consensus recommendations for GH therapy in GHD adolescent survivors of childhood cancer during the transition period

H Gleeson1, A Whitehouse1, L Smethurst2, S Shalet2, B Brennan2 & P Clayton1,2

1St Mary’s Hospital, Manchester, UK; 2Christie Hospital, Manchester, UK.

Background: Re-evaluation of the diagnosis of GHD at the completion of linear growth is a key task.

Objectives: To audit the impact of consensus recommendations on diagnosis of GHD and initiation of GH therapy in adolescents previously treated for a brain tumour (BT) or haematological malignancy (HM).

Population: Sixty one patients who had received GH therapy until final height following treatment for a BT (n=40) or a HM (n=21) were identified and would be considered within ‘a high likelihood category’ for retesting as GHD (initial IGF-I test, followed by GH test if IGF-I > −2SDS). Of the BT patients 20 had involvement of the hypothalamic pituitary axis (BTHP) and had >3 other pituitary deficits, and by guidelines would not require retesting. Twenty had tumours distant from the HP axis (BTD).

Results: Of the 61 patients, three patients did not attend for retesting. All 20 BTHP patients were eligible for continuous GH therapy without retesting; however, seven were tested, with all except one fulfilling the criteria for GHD (IGF-1 SDS <−2 or peak GH <5 mcg/l). Of the 20 BTD patients 13 had IGF-1 measurements, 7 of whom had an IGF-1<−2 SDS, 5 of these underwent GH provocative testing, all of whom had GH levels of <5 mcg/l. Nine others were diagnosed as GHD on provocative testing. In contrast, of the 21 patients with HM 15 patients had IGF-1 measurements, only one of whom had a level <−2 SDS. Ten were diagnosed as GHD on provocative testing.

After retesting, 46 out of 58 patients were eligible for GH therapy in the transition period. However only 25 eligible patients (54%) restarted or continued GH therapy.

Conclusions: Current guidelines are effective for identifying patients with high likelihood of GHD (IGF-I levels in BT patients), but HM patients require IGF-I and GH testing. However our current endocrine care is failing to educate and encourage adolescents with GHD to restart GH therapy after the completion of growth.

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